Provider Demographics
NPI:1588717144
Name:TOLETE-ROTOR, HERMINIA AGATEP (MD)
Entity type:Individual
Prefix:DR
First Name:HERMINIA
Middle Name:AGATEP
Last Name:TOLETE-ROTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:197-21 MCLAUGHLIN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLISWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11423
Mailing Address - Country:US
Mailing Address - Phone:646-387-2782
Mailing Address - Fax:212-879-1910
Practice Address - Street 1:965 5TH AVE OFC 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1721
Practice Address - Country:US
Practice Address - Phone:646-387-2782
Practice Address - Fax:212-879-1910
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY166517208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC12250Medicare UPIN