Healthcare Provider Details

I. General information

NPI: 1417973074
Provider Name (Legal Business Name): CORI A PANE F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FRONT ST
VESTAL NY
13850-1559
US

IV. Provider business mailing address

33 LEWIS RD 2ND FL
BINGHAMTON NY
13905-1040
US

V. Phone/Fax

Practice location:
  • Phone: 607-748-7468
  • Fax: 607-754-6130
Mailing address:
  • Phone: 607-729-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: