1174861900 NPI number — EVANGELINE TORRES REYES-PASTORELLA

Table of content: EVANGELINE TORRES REYES-PASTORELLA (NPI 1174861900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174861900 NPI number — EVANGELINE TORRES REYES-PASTORELLA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES-PASTORELLA
Provider First Name:
EVANGELINE
Provider Middle Name:
TORRES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REYES
Provider Other First Name:
EVANGELINE
Provider Other Middle Name:
TORRES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174861900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 GRAND ST
Provider Second Line Business Mailing Address:
3RD FL, CREDENTIALING MANAGER
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10990-1035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-987-3906
Provider Business Mailing Address Fax Number:
845-987-5979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WOODS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALHALLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10595-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-909-9018
Provider Business Practice Location Address Fax Number:
914-909-9028
Provider Enumeration Date:
01/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  337606 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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