Provider Demographics
NPI:1821078460
Name:CORLEY, PAUL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:CORLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11064 QUEENS BOULEVARD
Mailing Address - Street 2:BOX 129
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6347
Mailing Address - Country:US
Mailing Address - Phone:718-541-1449
Mailing Address - Fax:718-712-3343
Practice Address - Street 1:ONE CROSS ISLAND PLAZA
Practice Address - Street 2:SUITE 220A
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1484
Practice Address - Country:US
Practice Address - Phone:718-541-1449
Practice Address - Fax:718-712-3343
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1745622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01757693Medicaid
NY7334026OtherGROUP HEALTH INC
NY291673OtherMANAGED HEALTH NETWORK
NY06L881Medicare ID - Type Unspecified
F41576Medicare UPIN