Healthcare Provider Details

I. General information

NPI: 1184619298
Provider Name (Legal Business Name): AMY HELEN KOROBOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 PARK AVE
HUNTINGTON NY
11743-2779
US

IV. Provider business mailing address

325 PARK AVE
HUNTINGTON NY
11743-2779
US

V. Phone/Fax

Practice location:
  • Phone: 631-367-5391
  • Fax:
Mailing address:
  • Phone: 631-367-5391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number176143
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number176143
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number176143
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: