Provider Demographics
NPI:1336460989
Name:SISON, CORINNA PANLILIO (MD)
Entity Type:Individual
Prefix:
First Name:CORINNA
Middle Name:PANLILIO
Last Name:SISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CORINNA
Other - Middle Name:MARTINEZ
Other - Last Name:PANLILIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:515 E 72ND ST
Mailing Address - Street 2:APT 20K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4032
Mailing Address - Country:US
Mailing Address - Phone:732-735-3868
Mailing Address - Fax:
Practice Address - Street 1:515 E 72ND ST
Practice Address - Street 2:APT 20K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4032
Practice Address - Country:US
Practice Address - Phone:732-735-3868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275870208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice