Basic Information
Provider Information
NPI: 1811381858
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TORNG
FirstName: PERRY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 71 HAYNES ST
Address2:  
City: MANCHESTER
State: CT
PostalCode: 060404131
CountryCode: US
TelephoneNumber: 8605334679
FaxNumber: 8606454151
Practice Location
Address1: 71 HAYNES ST
Address2:  
City: MANCHESTER
State: CT
PostalCode: 06040
CountryCode: US
TelephoneNumber: 8605334679
FaxNumber: 8606454151
Other Information
ProviderEnumerationDate: 03/27/2015
LastUpdateDate: 11/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X57081CTY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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