MEDICARE: MAXINE ORRIS MD

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	207R00000X	Internal Medicine Physician	222807	NY

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

General Provider Information

NPI Number	:	1720040702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXINE ORRIS MD

Provider Business Mailing Address
First Line	:	415 CENTRAL PARK W
Second Line	:	SUITE 6D
City	:	NEW YORK
State	:	NY
Zip	:	10025-4856
Country	:	US
Telephone Number	:	917-692-9070
Fax Number	:	718-964-2364

Provider Business Practice Location Address
First Line	:	1192 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3018
Country	:	US
Telephone Number	:	718-963-2300
Fax Number	:	718-963-2364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	11/05/2010

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