Provider Demographics
NPI:1790346963
Name:GONERA, COREY KRISTOFFER (PMHNP)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:KRISTOFFER
Last Name:GONERA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MADISON SQ W FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1629
Mailing Address - Country:US
Mailing Address - Phone:917-765-2009
Mailing Address - Fax:
Practice Address - Street 1:333 E 38TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2772
Practice Address - Country:US
Practice Address - Phone:646-501-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY696901163W00000X
NY402685363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse