Provider Demographics
NPI:1184622128
Name:CORNACCHIA, LOUIS G III (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:G
Last Name:CORNACCHIA
Suffix:III
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 1:110 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:POINT LOOKOUT
Mailing Address - State:NY
Mailing Address - Zip Code:11569-3029
Mailing Address - Country:US
Mailing Address - Phone:516-255-0350
Mailing Address - Fax:516-240-6555
Practice Address - Street 1:411 STATE RT 17 STE 110
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-3016
Practice Address - Country:US
Practice Address - Phone:516-255-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY203236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG28323Medicare UPIN