Provider Demographics
NPI:1467423764
Name:CORSONES, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:CORSONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4626
Mailing Address - Country:US
Mailing Address - Phone:845-334-2729
Mailing Address - Fax:845-802-7362
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4626
Practice Address - Country:US
Practice Address - Phone:845-334-2729
Practice Address - Fax:845-802-7362
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY117133OtherMVP HEALTH PLAN
NY00725333Medicaid
NY00725333Medicaid
B19299Medicare UPIN