Provider Demographics
NPI:1043253404
Name:CORCORAN, CHRISTINE (NP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SPRING MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4947
Mailing Address - Country:US
Mailing Address - Phone:914-736-7726
Mailing Address - Fax:
Practice Address - Street 1:7 CROTON AVE
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-5203
Practice Address - Country:US
Practice Address - Phone:914-682-5800
Practice Address - Fax:914-682-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333829-1363L00000X
NY403434363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q57711Medicare UPIN
NY1378G1Medicare ID - Type Unspecified