Provider Demographics
NPI:1346203569
Name:ORELLANA, JORGE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:ORELLANA
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 1:8707 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3609
Mailing Address - Country:US
Mailing Address - Phone:718-257-7777
Mailing Address - Fax:718-257-8990
Practice Address - Street 1:8707 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3609
Practice Address - Country:US
Practice Address - Phone:718-257-7777
Practice Address - Fax:718-257-8990
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG55941Medicare UPIN
NY00V211Medicare ID - Type Unspecified