Provider Demographics
NPI:1669123089
Name:CORBETT, ELISABETH (PA)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:CORBETT
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 PICKWICK DR FL 2
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3133
Mailing Address - Country:US
Mailing Address - Phone:570-529-4056
Mailing Address - Fax:
Practice Address - Street 1:5 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053
Practice Address - Country:US
Practice Address - Phone:607-844-8181
Practice Address - Fax:607-844-4288
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027932363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant