Provider Demographics
NPI:1164280483
Name:CORRIS, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 6TH AVE STE B2
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9745
Mailing Address - Country:US
Mailing Address - Phone:856-288-3400
Mailing Address - Fax:
Practice Address - Street 1:199 6TH AVE STE B2
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9745
Practice Address - Country:US
Practice Address - Phone:856-288-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program