Provider Demographics
NPI:1598077190
Name:CORBO, STEPHEN (SLP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CORBO
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W 122ND ST APT 66
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5310
Mailing Address - Country:US
Mailing Address - Phone:347-604-1630
Mailing Address - Fax:
Practice Address - Street 1:303 W 122ND ST APT 66
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5310
Practice Address - Country:US
Practice Address - Phone:347-604-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020068-1OtherNY OFFICE OF PROFESSIONS REGISTRATION CERTIFICATE
14028537OtherAMERICAN SPEECH AND HEARING ASSOCIATION