Provider Demographics
NPI:1154834935
Name:COREY, ANITA LUCILLE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:LUCILLE
Last Name:COREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1375
Mailing Address - Country:US
Mailing Address - Phone:732-740-6505
Mailing Address - Fax:
Practice Address - Street 1:4810 BELMAR BLVD
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6952
Practice Address - Country:US
Practice Address - Phone:732-938-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021635363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical