Healthcare Provider Details

I. General information

NPI: 1740456169
Provider Name (Legal Business Name): CORRINE RENNE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 FRANKLIN AVE
FRANKLIN SQUARE NY
11010
US

IV. Provider business mailing address

397 FRANKLIN AVE
FRANKLIN SQUARE NY
11010-1227
US

V. Phone/Fax

Practice location:
  • Phone: 516-233-1919
  • Fax: 516-977-5137
Mailing address:
  • Phone: 516-233-1919
  • Fax: 516-977-5137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN006262
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: