Provider Demographics
NPI:1881917854
Name:ORIN, DMITRY
Entity type:Individual
Prefix:MR
First Name:DMITRY
Middle Name:
Last Name:ORIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 E 17 ST AP 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5704
Mailing Address - Country:US
Mailing Address - Phone:347-306-1901
Mailing Address - Fax:718-421-6185
Practice Address - Street 1:3401 AVENUE H
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3350
Practice Address - Country:US
Practice Address - Phone:718-859-3000
Practice Address - Fax:719-421-6185
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045497183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist