Healthcare Provider Details

I. General information

NPI: 1457524084
Provider Name (Legal Business Name): ORRIS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1192 BROADWAY
BROOKLYN NY
11221-3018
US

IV. Provider business mailing address

415 CENTRAL PARK W 6D
NEW YORK NY
10025-4856
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-2300
  • Fax: 718-963-2364
Mailing address:
  • Phone: 917-692-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number222807
License Number StateNY

VIII. Authorized Official

Name: MAXINE ORRIS
Title or Position: SOLE PROPRIETER
Credential:
Phone: 718-963-2300