Provider Demographics
NPI:1578380432
Name:SUAREZ TORRES, HERBERT ISRAEL (LDO)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:ISRAEL
Last Name:SUAREZ TORRES
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 ADAMS RD # APR2B
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-2225
Mailing Address - Country:US
Mailing Address - Phone:516-580-6302
Mailing Address - Fax:
Practice Address - Street 1:458 BROOME ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2651
Practice Address - Country:US
Practice Address - Phone:212-343-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01045201156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician