Provider Demographics
NPI:1215198510
Name:JABEN, KOREY ALYSE (MD)
Entity Type:Individual
Prefix:
First Name:KOREY
Middle Name:ALYSE
Last Name:JABEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 YORK AVE APT 18J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6342
Mailing Address - Country:US
Mailing Address - Phone:704-564-2505
Mailing Address - Fax:
Practice Address - Street 1:16 E 60TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1096
Practice Address - Country:US
Practice Address - Phone:212-639-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10032336207L00000X
GA73567207W00000X
NY290130-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology