Provider Demographics
NPI:1457890105
Name:TORRES, JONATHAN (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:TORRES
Suffix:
Gender:M
Credentials:PA-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:1134 STATE ROUTE 29
Practice Address - Street 2:GREENWICH MEDICAL CENTER
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-6107
Practice Address - Country:US
Practice Address - Phone:518-692-9861
Practice Address - Fax:518-692-7947
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2024-09-06
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Provider Licenses
StateLicense IDTaxonomies
NY020635363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020635OtherLICENSE