1467431486 NPI number — DR. MARK J CORAPI MD

Table of content: DR. MARK J CORAPI MD (NPI 1467431486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467431486 NPI number — DR. MARK J CORAPI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORAPI
Provider First Name:
MARK
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467431486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 STATION PLZ N
Provider Second Line Business Mailing Address:
SUITE 310
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-663-3822
Provider Business Mailing Address Fax Number:
516-663-4740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 STATION PLZ N
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
MINEOLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11501-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-663-2051
Provider Business Practice Location Address Fax Number:
516-663-4740
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  NYS154526 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 122 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1477073 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4336593 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110033181 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01146538 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 73D421 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP797 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2C8228 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431651N . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1307776 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2500269 . This is a "GHI" identifier . This identifiers is of the category "OTHER".




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