Provider Demographics
NPI:1013359777
Name:MARTIN R BOORIN, DMD PC
Entity Type:Organization
Organization Name:MARTIN R BOORIN, DMD PC
Other - Org Name:DENTAL ANESTHESIA SERVICES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOORIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:631-940-3690
Mailing Address - Street 1:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-0089
Mailing Address - Country:US
Mailing Address - Phone:631-940-3690
Mailing Address - Fax:631-940-7227
Practice Address - Street 1:1087 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6340
Practice Address - Country:US
Practice Address - Phone:516-776-0716
Practice Address - Fax:631-940-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0399971223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00023886OtherRAILROAD
NYT32127Medicare UPIN