Provider Demographics
NPI:1043216435
Name:BOORIN, MARTIN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:R
Last Name:BOORIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 107
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039997122300000X, 1223D0004X
NJ22DIO1606400122300000X
CT7066122300000X
CT70061223D0004X
NJ2201016064001223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01020286Medicaid
NYP00023886OtherRAILROAD
NY0421REMedicare ID - Type Unspecified
NYT32127Medicare UPIN