Healthcare Provider Details

I. General information

NPI: 1437231123
Provider Name (Legal Business Name): LOUIS A CORSARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BEDFORD RD MOUNT KISCO MEDICAL GROUP PC
KATONAH NY
10536
US

IV. Provider business mailing address

90 SOUTH BEDFORD RD MOUNT KISCO MEDICAL GROUP PC
MOUNT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-232-3135
  • Fax: 914-242-1516
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number103659
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: