Provider Demographics
NPI:1881667764
Name:CORVALAN-SCHMIDT, ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:CORVALAN-SCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2228
Mailing Address - Country:US
Mailing Address - Phone:845-306-0910
Mailing Address - Fax:845-306-0911
Practice Address - Street 1:2891 ROUTE 22
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-2228
Practice Address - Country:US
Practice Address - Phone:845-306-0910
Practice Address - Fax:845-306-0911
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02948896Medicaid
NY02948896Medicaid
NY563111Medicare PIN