Provider Demographics
NPI:1770635344
Name:CORRENTE, LISA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:CORRENTE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3620 E TREMONT AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2038
Mailing Address - Country:US
Mailing Address - Phone:718-484-3989
Mailing Address - Fax:718-484-8757
Practice Address - Street 1:3620 E TREMONT AVE STE 104
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2038
Practice Address - Country:US
Practice Address - Phone:718-484-3989
Practice Address - Fax:718-484-8757
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA-836482085R0202X
PAMD4242642085R0202X
FLME1096662085R0202X
NJ25MA088864002085R0202X
CT493552085R0202X
VT042-00121122085R0202X
TN467872085R0202X
NH150992085R0202X
MDD717242085R0202X
NY2227912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101341974Medicaid
NY03494846Medicaid
PA081756Medicare ID - Type UnspecifiedPA MEDICARE