Healthcare Provider Details

I. General information

NPI: 1538430350
Provider Name (Legal Business Name): JAMIE MARIE CORCORAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 09/20/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 EAST 17 ST BKLYN NY COMPREHENSIVE RESOURCES
BROOKLYN NY
11229-1510
US

IV. Provider business mailing address

PO BOX 20025
NEW YORK NY
10025-1510
US

V. Phone/Fax

Practice location:
  • Phone: 646-600-3396
  • Fax:
Mailing address:
  • Phone: 646-600-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number307464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: