Healthcare Provider Details

I. General information

NPI: 1154606911
Provider Name (Legal Business Name): CORINA LANGERT-DEGORI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 WATERS PL
BRONX NY
10461-2700
US

IV. Provider business mailing address

17 BROADVIEW AVE
KINGS PARK NY
11754-1001
US

V. Phone/Fax

Practice location:
  • Phone: 347-493-8569
  • Fax:
Mailing address:
  • Phone: 347-493-8569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number390573-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: