Healthcare Provider Details

I. General information

NPI: 1922269976
Provider Name (Legal Business Name): AMY KOREEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 ELM ST
HUNTINGTON NY
11743-3402
US

IV. Provider business mailing address

28 ELM ST
HUNTINGTON NY
11743-3402
US

V. Phone/Fax

Practice location:
  • Phone: 631-423-8368
  • Fax: 631-421-1914
Mailing address:
  • Phone: 631-423-8368
  • Fax: 631-421-1914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number184905
License Number StateNY

VIII. Authorized Official

Name: DR. AMY R KOREEN
Title or Position: OWNER
Credential: MD PC
Phone: 631-423-8369