MEDICARE: CORR HEALTH EC, PC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1639035447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORR HEALTH EC, PC

Provider Business Mailing Address
First Line	:	961 BROADWAY STE 103
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	961 BROADWAY STE 103
Second Line	:
City	:	WOODMERE
State	:	NY
Zip	:	11598-1733
Country	:	US
Telephone Number	:	212-516-8548
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JONATHAN PAULL
Credential	:
Telephone Number	:	313-516-8548

Provider Enumeration Date	:	12/25/2025
Last Update Date	:	12/25/2025

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