Healthcare Provider Details

I. General information

NPI: 1891086401
Provider Name (Legal Business Name): ROBERT ANTHONY CORSO I R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 PARK AVE
HUNTINGTON NY
11743-4516
US

IV. Provider business mailing address

790 PARK AVE
HUNTINGTON NY
11743-4516
US

V. Phone/Fax

Practice location:
  • Phone: 163-158-2849
  • Fax:
Mailing address:
  • Phone: 163-158-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number367018
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number367018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: