Provider Demographics
NPI:1437499191
Name:CORSELLO, TONI LEIGH
Entity Type:Individual
Prefix:MISS
First Name:TONI
Middle Name:LEIGH
Last Name:CORSELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BEACH 124TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1338
Mailing Address - Country:US
Mailing Address - Phone:917-567-6353
Mailing Address - Fax:
Practice Address - Street 1:153 BEACH 124TH ST
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1839
Practice Address - Country:US
Practice Address - Phone:917-567-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY702681131174400000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency