MEDICARE: DR. MARTIN R. BOORIN DMD

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	122300000X	Dentist	039997	NY
2	122300000X	Dentist	22DIO1606400	NJ
3	122300000X	Dentist	7066	CT
4	1223D0004X	Dental Anesthesiology	039997	NY
5	1223D0004X	Dental Anesthesiology	7006	CT
6	1223D0004X	Dental Anesthesiology	220101606400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P00023886	OTHER	NY	RAILROAD

General Provider Information

NPI Number	:	1043216435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN R. BOORIN DMD

Provider Business Mailing Address
First Line	:	P.O. BOX 107
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	06/19/2013

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