Provider Demographics
NPI:1124026026
Name:CORONA, ANTONIO P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:P
Last Name:CORONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RANCH LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4601
Mailing Address - Country:US
Mailing Address - Phone:516-731-4655
Mailing Address - Fax:516-731-4655
Practice Address - Street 1:1 RANCH LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-4601
Practice Address - Country:US
Practice Address - Phone:516-731-4655
Practice Address - Fax:516-731-4655
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00235910Medicaid
C08271Medicare UPIN
NY314002Medicare PIN