Healthcare Provider Details

I. General information

NPI: 1831181064
Provider Name (Legal Business Name): MARIA CORSARO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HEMPSTEAD TPKE 500
EAST MEADOW NY
11554-1724
US

IV. Provider business mailing address

450 CLARKSON AVE 1198
BROOKLYN NY
11203-2056
US

V. Phone/Fax

Practice location:
  • Phone: 516-542-1090
  • Fax: 516-794-8165
Mailing address:
  • Phone: 718-270-1603
  • Fax: 718-270-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number212120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: