Healthcare Provider Details

I. General information

NPI: 1699038851
Provider Name (Legal Business Name): STEPHANIE COREY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 PORTLAND AVE BLDG 3
ROCHESTER NY
14621
US

IV. Provider business mailing address

1425 PORTLAND AVE BLDG 3
ROCHESTER NY
14621-3095
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number282589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: