Provider Demographics
NPI:1922075480
Name:CORBETT-RENNER, ELIZABETH ANNE (RPAC-PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:CORBETT-RENNER
Suffix:
Gender:F
Credentials:RPAC-PT
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:RENNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPAC-PT
Mailing Address - Street 1:675 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609
Mailing Address - Country:US
Mailing Address - Phone:585-288-1260
Mailing Address - Fax:585-654-6053
Practice Address - Street 1:675 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609
Practice Address - Country:US
Practice Address - Phone:585-288-1260
Practice Address - Fax:585-654-6053
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006888-1363A00000X
NY009588174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA1306Medicare PIN