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General NPI Number Information
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NPI Number | 1366617763
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Entity Type | Organization
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Legal Business Name | PAUL A. CORLEY, M.D., P.C.
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 1 CROSS ISLAND PLZ SUITE 220A
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City | ROSEDALE
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State | NY
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Zip | 11422-1484
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Country | US
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Telephone | 718-541-1449
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Fax | 718-712-3343
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Provider Business Mailing Address
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Address Line | 11064 QUEENS BLVD #129
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City | FOREST HILLS
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State | NY
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Zip | 11375-6347
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Country | US
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Telephone | 718-541-1449
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Fax | 718-712-3343
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL CORLEY
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Credential | M.D.
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Telephone | 718-541-1449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 174562
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License Number State | NY
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