Provider Demographics
NPI:1568425684
Name:CORREALE, DEBORAH A (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:CORREALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:707 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2650
Mailing Address - Country:US
Mailing Address - Phone:845-333-7575
Mailing Address - Fax:845-333-7202
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:HOSPITALIST DEPARTMENT
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-421-4000
Practice Address - Fax:570-420-2459
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011919363AM0700X
MEPA001076363AM0700X
PAMA003155L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02718725Medicaid
MEP00457867OtherRAILROAD MEDICARE
PA078293PZPMedicare ID - Type Unspecified