Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 039997 | NY |
N | 122300000X | Dentist | 22DIO1606400 | NJ |
N | 122300000X | Dentist | 7066 | CT |
Y | 1223D0004X | Dentist Anesthesiologist | 039997 | NY |
N | 1223D0004X | Dentist Anesthesiologist | 220101606400 | NJ |
N | 1223D0004X | Dentist Anesthesiologist | 7006 | CT |
NPI | 1043216435 |
---|---|
Provider Name | Dr. Martin R. Boorin |
First Address | Huntington Station, NY 11746 |
Second Address | Dix Hills, NY 11746-6340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 19/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01020286 | (05) | NY |
P00023886 | RAILROAD (01) | NY |
T32127 | (02) | NY |