Provider Demographics
NPI:1982115531
Name:CORIOLAN, ANDINE N
Entity Type:Individual
Prefix:
First Name:ANDINE
Middle Name:N
Last Name:CORIOLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3603
Mailing Address - Country:US
Mailing Address - Phone:914-228-6775
Mailing Address - Fax:
Practice Address - Street 1:165 E 54TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3603
Practice Address - Country:US
Practice Address - Phone:914-228-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-22
Last Update Date:2017-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator