Provider Demographics
NPI:1043572381
Name:ORELLANA, WILFRED (MSED)
Entity Type:Individual
Prefix:
First Name:WILFRED
Middle Name:
Last Name:ORELLANA
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HOLMES
Mailing Address - State:NY
Mailing Address - Zip Code:12531-5005
Mailing Address - Country:US
Mailing Address - Phone:845-878-5017
Mailing Address - Fax:
Practice Address - Street 1:84 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:HOLMES
Practice Address - State:NY
Practice Address - Zip Code:12531-5005
Practice Address - Country:US
Practice Address - Phone:845-878-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1098851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist