Provider Demographics
NPI:1073665485
Name:ORENBERG, SCOTT D (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:ORENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 MORRIS AVE STE 204
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1224
Practice Address - Country:US
Practice Address - Phone:973-763-5010
Practice Address - Fax:973-763-8163
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB061024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG07357Medicare UPIN
NJ458203Medicare ID - Type Unspecified