1568425684 NPI number — DEBORAH A. CORREALE PA-C

Table of content: DEBORAH A. CORREALE PA-C (NPI 1568425684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568425684 NPI number — DEBORAH A. CORREALE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORREALE
Provider First Name:
DEBORAH
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENNINGS
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568425684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10940-2650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-333-7575
Provider Business Mailing Address Fax Number:
845-333-7202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 E BROWN ST
Provider Second Line Business Practice Location Address:
HOSPITALIST DEPARTMENT
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-4000
Provider Business Practice Location Address Fax Number:
570-420-2459
Provider Enumeration Date:
04/10/2006

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: 363AM0700X , with the licence number:  011919 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA001076 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: MA003155L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02718725 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00457867 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".