Provider Demographics
NPI:1588954614
Name:TORRE, JENNY ANN (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:ANN
Last Name:TORRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:ANN
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:258 HOOSICK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2444
Practice Address - Country:US
Practice Address - Phone:518-272-0232
Practice Address - Fax:518-272-4083
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63093390200000X
NY273023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
63093OtherAMC ID NUMBER