Healthcare Provider Details

I. General information

NPI: 1154767507
Provider Name (Legal Business Name): ROBERT M COREY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 BRENTWOOD DR STE B
ITHACA NY
14850-1866
US

IV. Provider business mailing address

10 BRENTWOOD DR STE B
ITHACA NY
14850-1866
US

V. Phone/Fax

Practice location:
  • Phone: 607-266-0073
  • Fax:
Mailing address:
  • Phone: 607-266-0073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number76143
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number309080
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: