Provider Demographics
NPI:1982131751
Name:WENDY SANZONE-KORKUS
Entity Type:Organization
Organization Name:WENDY SANZONE-KORKUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EDUCATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SANZONE-KORKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-478-1422
Mailing Address - Street 1:260 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2731
Mailing Address - Country:US
Mailing Address - Phone:631-478-1422
Mailing Address - Fax:
Practice Address - Street 1:260 7TH ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2731
Practice Address - Country:US
Practice Address - Phone:631-478-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103K00000XOtherA J BEHAVIORAL