Provider Demographics
NPI:1467720391
Name:CORNAX, MARY P (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:CORNAX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-3507
Mailing Address - Country:US
Mailing Address - Phone:845-897-6700
Mailing Address - Fax:845-897-6719
Practice Address - Street 1:2012 ROUTE 52
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-3507
Practice Address - Country:US
Practice Address - Phone:845-897-6700
Practice Address - Fax:845-897-6719
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263546-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse