Provider Demographics
NPI:1700936341
Name:CORPUZ, MARILOU (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILOU
Middle Name:
Last Name:CORPUZ
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:OLMMC, DEPT. OF MEDICINE
Mailing Address - Street 2:600 EAST 233RD ST
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:718-920-9036
Mailing Address - Fax:718-920-9036
Practice Address - Street 1:600 E 233RD ST
Practice Address - Street 2:MONTEFIORE MEDICAL CENTER, NORTH DIVISION, DEPT. OF MED
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2604
Practice Address - Country:US
Practice Address - Phone:718-920-9144
Practice Address - Fax:718-920-9036
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01271961Medicaid
NY05G421Medicare ID - Type Unspecified
NY01271961Medicaid