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General NPI Number Information
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NPI Number | 1720437593
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER PI CORSA DMD MS PC
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Dates
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Enumeration Date | 06/12/2016
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Last Update Date | 06/12/2016
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Provider Practice Location Address
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Address Line | 1401 ROUTE 300 STE 1081
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City | NEWBURGH
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State | NY
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Zip | 12550-6905
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Country | US
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Telephone | 845-564-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 432 YORK DR
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City | BENICIA
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State | CA
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Zip | 94510-1425
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER CORSA
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Credential |
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Telephone | 650-204-1357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 052958
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License Number State | NY
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