Provider Demographics
NPI:1912873316
Name:FORTERE, EDWIN
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:FORTERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800B BROOKRIDGE DR APT 97
Mailing Address - Street 2:
Mailing Address - City:VALLEY COTTAGE
Mailing Address - State:NY
Mailing Address - Zip Code:10989-1894
Mailing Address - Country:US
Mailing Address - Phone:845-570-0078
Mailing Address - Fax:
Practice Address - Street 1:800B BROOKRIDGE DR
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1855
Practice Address - Country:US
Practice Address - Phone:845-570-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY973166-01163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Multi-Specialty