Provider Demographics
NPI:1255654471
Name:CORBANESE, PHILIPPE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:
Last Name:CORBANESE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ELLWOOD AVE
Mailing Address - Street 2:APT. 2F
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3448
Mailing Address - Country:US
Mailing Address - Phone:914-664-0123
Mailing Address - Fax:
Practice Address - Street 1:245 5TH AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8728
Practice Address - Country:US
Practice Address - Phone:646-935-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist