Provider Demographics
NPI:1356974158
Name:TORRES, JOQUIN
Entity type:Individual
Prefix:
First Name:JOQUIN
Middle Name:
Last Name:TORRES
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:PO BOX 1099
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07602-1099
Mailing Address - Country:US
Mailing Address - Phone:201-488-0170
Mailing Address - Fax:201-488-0172
Practice Address - Street 1:214 STATE ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5500
Practice Address - Country:US
Practice Address - Phone:201-488-0170
Practice Address - Fax:201-488-0170
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ84-2065012Medicaid