Provider Demographics
NPI:1528622156
Name:TORCHON, STEPHANE DON (STEPHANE)
Entity type:Individual
Prefix:
First Name:STEPHANE
Middle Name:DON
Last Name:TORCHON
Suffix:
Gender:M
Credentials:STEPHANE
Other - Prefix:
Other - First Name:STEPHANE
Other - Middle Name:DON
Other - Last Name:TORCHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3254
Mailing Address - Country:US
Mailing Address - Phone:631-896-0286
Mailing Address - Fax:
Practice Address - Street 1:17 E 23RD ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3254
Practice Address - Country:US
Practice Address - Phone:631-896-0286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327483474172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver