Provider Demographics
NPI:1942985163
Name:CORY, MIRIAM (RN, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:CORY
Suffix:
Gender:F
Credentials:RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STANWICH RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2356
Mailing Address - Country:US
Mailing Address - Phone:631-312-0938
Mailing Address - Fax:
Practice Address - Street 1:500 COMMACK RD UNIT 150F
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5009
Practice Address - Country:US
Practice Address - Phone:631-499-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY589995-01163W00000X
NYF383586-01363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse