Provider Demographics
NPI:1578721262
Name:CORBO, SALLY ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SALLY ANN
Middle Name:
Last Name:CORBO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:SALLY ANN
Other - Middle Name:
Other - Last Name:PELAIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:585 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7505
Mailing Address - Country:US
Mailing Address - Phone:973-228-4250
Mailing Address - Fax:973-228-6603
Practice Address - Street 1:585 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 5C
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7505
Practice Address - Country:US
Practice Address - Phone:973-228-4250
Practice Address - Fax:973-228-6603
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC05320800364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health