Provider Demographics
NPI:1013268267
Name:BARRY, CORINNE PATRICIA
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:PATRICIA
Last Name:BARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CORINNE
Other - Middle Name:PATRICIA
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4022 192ND ST APT 3
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4022 192ND ST APT 3
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2925
Practice Address - Country:US
Practice Address - Phone:516-661-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY457270101174400000X
NY598768121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist