Provider Demographics
NPI:1255323580
Name:NOTIS, COREY M (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:M
Last Name:NOTIS
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:155 MORRIS AVE
Mailing Address - Street 2:3RD FLOOR, SUITE 2
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1225
Mailing Address - Country:US
Mailing Address - Phone:973-232-6900
Mailing Address - Fax:973-232-6911
Practice Address - Street 1:155 MORRIS AVE
Practice Address - Street 2:3RD FLOOR, SUITE 2
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1225
Practice Address - Country:US
Practice Address - Phone:973-232-6900
Practice Address - Fax:973-232-6911
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1817481207W00000X
NJMA053905207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F54493Medicare UPIN
785611R35Medicare ID - Type Unspecified