MEDICARE: DR. LISA A CORRENTE 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	2085R0202X	Diagnostic Radiology Physician	A-83648	CA
2	2085R0202X	Diagnostic Radiology Physician	MD424264	PA
3	2085R0202X	Diagnostic Radiology Physician	ME109666	FL
4	2085R0202X	Diagnostic Radiology Physician	25MA08886400	NJ
5	2085R0202X	Diagnostic Radiology Physician	49355	CT
6	2085R0202X	Diagnostic Radiology Physician	042-0012112	VT
7	2085R0202X	Diagnostic Radiology Physician	46787	TN
8	2085R0202X	Diagnostic Radiology Physician	15099	NH
9	2085R0202X	Diagnostic Radiology Physician	D71724	MD
10	2085R0202X	Diagnostic Radiology Physician	222791	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770635344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA A CORRENTE MD

Provider Business Mailing Address
First Line	:	3620 E TREMONT AVE STE 104
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-2038
Country	:	US
Telephone Number	:	718-484-3989
Fax Number	:	718-484-8757

Provider Business Practice Location Address
First Line	:	3620 E TREMONT AVE STE 104
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-2038
Country	:	US
Telephone Number	:	718-484-3989
Fax Number	:	718-484-8757

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	06/08/2022

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