Provider Demographics
NPI:1942896212
Name:ASSEO, CORRIE (PA-C)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:
Last Name:ASSEO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 WINCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4357
Mailing Address - Country:US
Mailing Address - Phone:201-390-1804
Mailing Address - Fax:
Practice Address - Street 1:2800 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4201
Practice Address - Country:US
Practice Address - Phone:203-576-5708
Practice Address - Fax:203-367-8392
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5143363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant