Provider Demographics
NPI:1154492429
Name:ORSEN, MAUREEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:M
Last Name:ORSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 SUNKEN MEADOW ROAD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754
Mailing Address - Country:US
Mailing Address - Phone:631-269-5800
Mailing Address - Fax:631-269-5876
Practice Address - Street 1:395 SUNKEN MEADOW ROAD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754
Practice Address - Country:US
Practice Address - Phone:631-269-5800
Practice Address - Fax:631-269-5876
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129589-1207R00000X
NY129589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00774658Medicaid
NY336581Medicare ID - Type UnspecifiedCARRIER PROVIDER NUMBER
NY00774658Medicaid