Provider Demographics
NPI:1578851440
Name:CORBY, PATRICIA MIRANDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MIRANDA
Last Name:CORBY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 FIRST AVENUE
Mailing Address - Street 2:NYU COLLEGE OF DENTISTRY-BCCR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:212-998-9713
Mailing Address - Fax:212-995-4843
Practice Address - Street 1:421 1ST AVE
Practice Address - Street 2:NYU COLLEGE OF DENTISTRY-BCCR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4001
Practice Address - Country:US
Practice Address - Phone:212-998-9713
Practice Address - Fax:212-995-4843
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist