Provider Demographics
NPI:1740456169
Name:RENNE, CORRINE (DPM)
Entity type:Individual
Prefix:DR
First Name:CORRINE
Middle Name:
Last Name:RENNE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1227
Mailing Address - Country:US
Mailing Address - Phone:516-233-1919
Mailing Address - Fax:516-977-5137
Practice Address - Street 1:397 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010
Practice Address - Country:US
Practice Address - Phone:516-233-1919
Practice Address - Fax:516-977-5137
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006262213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery