Provider Demographics
NPI:1518098904
Name:ORBACH, GARY ALLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLAN
Last Name:ORBACH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:ALLAN
Other - Last Name:ORBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:30 CENTRAL PARK S
Mailing Address - Street 2:#5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1628
Mailing Address - Country:US
Mailing Address - Phone:212-371-6622
Mailing Address - Fax:212-371-6642
Practice Address - Street 1:30 CENTRAL PARK S
Practice Address - Street 2:#5A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1628
Practice Address - Country:US
Practice Address - Phone:212-371-6622
Practice Address - Fax:212-371-6642
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0402261223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics