Provider Demographics
NPI:1184909442
Name:LACORBINIERE, HENRIKA CONSUELA (MD)
Entity type:Individual
Prefix:
First Name:HENRIKA
Middle Name:CONSUELA
Last Name:LACORBINIERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 GREENLAWN AVE.
Mailing Address - Street 2:
Mailing Address - City:ISLIP TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11752
Mailing Address - Country:US
Mailing Address - Phone:646-823-5198
Mailing Address - Fax:
Practice Address - Street 1:259 BRISTOL STREET
Practice Address - Street 2:SUITE #241
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-495-7273
Practice Address - Fax:718-495-8294
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115619208000000X
TXE22652080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities