MEDICARE: DR. WILLIAM J KORNRICH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	182977	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144332198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM J KORNRICH MD

Provider Business Mailing Address
First Line	:	887 OLD COUNTRY RD
Second Line	:	SUITE A
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2115
Country	:	US
Telephone Number	:	631-727-6122
Fax Number	:	631-727-2672

Provider Business Practice Location Address
First Line	:	887 OLD COUNTRY RD
Second Line	:	SUITE A
City	:	RIVERHEAD
State	:	NY
Zip	:	11901-2115
Country	:	US
Telephone Number	:	631-727-6122
Fax Number	:	631-727-2672

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/10/2021

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