Provider Demographics
NPI:1053310672
Name:PINO-Y-TORRES, JOSE L (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:PINO-Y-TORRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2736
Mailing Address - Country:US
Mailing Address - Phone:906-225-7790
Mailing Address - Fax:906-225-7798
Practice Address - Street 1:113 POCONO DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-9466
Practice Address - Country:US
Practice Address - Phone:570-504-7210
Practice Address - Fax:570-955-2213
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426545174400000X
PAMD426454E2085R0001X
PAMD 426454 E2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5198607Medicaid
NY02683172Medicaid
PA101429160Medicaid
NY02683172Medicaid
PA093409Medicare PIN
NJ5198607Medicaid
PA101429160Medicaid