MEDICARE: MARTIN R BOORIN, DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0004X	Dental Anesthesiology	039997	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00023886	OTHER	NY	RAILROAD

General Provider Information

NPI Number	:	1013359777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN R BOORIN, DMD PC

Provider Business Mailing Address
First Line	:	PO BOX 107
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-0089
Country	:	US
Telephone Number	:	631-940-3690
Fax Number	:	631-940-7227

Provider Business Practice Location Address
First Line	:	1087 WESTMINSTER AVE
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-6340
Country	:	US
Telephone Number	:	516-776-0716
Fax Number	:	631-940-7227

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARTIN R BOORIN
Credential	:	DMD
Telephone Number	:	631-940-3690

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	07/23/2013

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