Provider Demographics
NPI:1164849907
Name:ESTREAM, CORNEILIA
Entity Type:Individual
Prefix:
First Name:CORNEILIA
Middle Name:
Last Name:ESTREAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORNEILIA
Other - Middle Name:
Other - Last Name:ESTREAM-SOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSED
Mailing Address - Street 1:1498 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-5911
Mailing Address - Country:US
Mailing Address - Phone:917-652-1172
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN ST STE 200
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4739
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY528773111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2272649OtherTEACHER ID