Provider Demographics
NPI:1770552614
Name:CORAZON, ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:CORAZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 TOTOWA AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-2125
Mailing Address - Country:US
Mailing Address - Phone:973-389-1300
Mailing Address - Fax:973-389-0138
Practice Address - Street 1:355 TOTOWA AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07502-2125
Practice Address - Country:US
Practice Address - Phone:973-389-1300
Practice Address - Fax:973-389-0138
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63961207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7232900Medicaid
NJ901381Medicare ID - Type Unspecified
NJ7232900Medicaid