Provider Demographics
NPI:1235897653
Name:CORONA ING INC
Entity Type:Organization
Organization Name:CORONA ING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGDASAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-406-9032
Mailing Address - Street 1:3719 108TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4176
Mailing Address - Country:US
Mailing Address - Phone:718-406-9032
Mailing Address - Fax:917-745-1561
Practice Address - Street 1:3719 108TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4176
Practice Address - Country:US
Practice Address - Phone:718-406-9032
Practice Address - Fax:917-745-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty