Provider Demographics
NPI:1699038158
Name:CORNIER, LOURDES
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:
Last Name:CORNIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230184
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-0184
Mailing Address - Country:US
Mailing Address - Phone:347-510-7386
Mailing Address - Fax:
Practice Address - Street 1:7201 4TH AVE APT A15
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2511
Practice Address - Country:US
Practice Address - Phone:347-510-7386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY774706174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist