Provider Demographics
NPI:1235137449
Name:ORENTREICH, DAVID SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:ORENTREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4115
Mailing Address - Country:US
Mailing Address - Phone:212-794-0800
Mailing Address - Fax:212-794-6261
Practice Address - Street 1:909 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4115
Practice Address - Country:US
Practice Address - Phone:212-794-0800
Practice Address - Fax:212-794-6261
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147024207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY44D781Medicare ID - Type Unspecified
NYB14715Medicare UPIN