Healthcare Provider Details

I. General information

NPI: 1861691792
Provider Name (Legal Business Name): CORINNE LEE FURNARI PA CCN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 49TH ST STE 503
NEW YORK NY
10019-7433
US

IV. Provider business mailing address

320 7TH AVE # 167
BROOKLYN NY
11215-4113
US

V. Phone/Fax

Practice location:
  • Phone: 212-586-2100
  • Fax:
Mailing address:
  • Phone: 212-608-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0034071
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number002837-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: