Basic Information
| Provider Information | |||||||||
| NPI: | 1154418234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ETINGIN | ||||||||
| FirstName: | ORLI | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1315 YORK AVE # 1 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100215304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127460373 | ||||||||
| FaxNumber: | 2127467481 | ||||||||
| Practice Location | |||||||||
| Address1: | 1315 YORK AVE # 1 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100215304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127462066 | ||||||||
| FaxNumber: | 2127463305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 146398 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 01020144 | 05 | NY | MEDICAID |