Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 031591 | NY |
NPI | 1114098076 |
---|---|
Provider Name | Dr. Barry Ortenberg |
First Address | Coram, NY 11727-0449 |
Second Address | Coram, NY 11727-0449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |