Provider Demographics
NPI:1164814315
Name:LECORPS, SIENA (FNP)
Entity Type:Individual
Prefix:
First Name:SIENA
Middle Name:
Last Name:LECORPS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36363 NEWARK NJ 07188 PHONE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07188-0001
Mailing Address - Country:US
Mailing Address - Phone:845-651-1400
Mailing Address - Fax:845-294-3758
Practice Address - Street 1:30 HATFIELD LN STE 208
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6768
Practice Address - Country:US
Practice Address - Phone:845-294-0994
Practice Address - Fax:845-294-8622
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345539363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY694621Medicaid