Provider Demographics
NPI:1669789996
Name:CORRIGAN, DEIRDRE (LAC)
Entity type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 ROUTE 145
Mailing Address - Street 2:
Mailing Address - City:PRESTON HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:12469
Mailing Address - Country:US
Mailing Address - Phone:917-882-4698
Mailing Address - Fax:
Practice Address - Street 1:39-89 50TH ST.
Practice Address - Street 2:APT. 1E
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:917-882-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0042891171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist