Healthcare Provider Details

I. General information

NPI: 1821078460
Provider Name (Legal Business Name): PAUL ANTHONY CORLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE CROSS ISLAND PLAZA SUITE 220A
ROSEDALE NY
11422-1484
US

IV. Provider business mailing address

11064 QUEENS BOULEVARD BOX 129
FOREST HILLS NY
11375-6347
US

V. Phone/Fax

Practice location:
  • Phone: 718-541-1449
  • Fax: 718-712-3343
Mailing address:
  • Phone: 718-541-1449
  • Fax: 718-712-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number174562
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: