Provider Demographics
NPI:1255359485
Name:CORBEN, JEFFREY (PT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:CORBEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 STEWART AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6611
Mailing Address - Country:US
Mailing Address - Phone:516-745-1177
Mailing Address - Fax:516-745-1189
Practice Address - Street 1:1103 STEWART AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4886
Practice Address - Country:US
Practice Address - Phone:516-745-1177
Practice Address - Fax:516-745-1189
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ06641Medicare PIN