MEDICARE: PAUL A. CORLEY, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	174562	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000196040101	OTHER		HEALTH PLUS
2	P2491206	OTHER		OXFORD
3	522BA1	OTHER	NY	EMPIRE BC/BS
4	363784	OTHER		MHN
5	7353654	OTHER		VALUE OPTIONS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	330553	OTHER	NY	CMS WELLCARE

General Provider Information

NPI Number	:	1366617763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL A. CORLEY, M.D., P.C.

Provider Business Mailing Address
First Line	:	11064 QUEENS BLVD
Second Line	:	#129
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6347
Country	:	US
Telephone Number	:	718-541-1449
Fax Number	:	718-712-3343

Provider Business Practice Location Address
First Line	:	1 CROSS ISLAND PLZ
Second Line	:	SUITE 220A
City	:	ROSEDALE
State	:	NY
Zip	:	11422-1484
Country	:	US
Telephone Number	:	718-541-1449
Fax Number	:	718-712-3343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL CORLEY
Credential	:	M.D.
Telephone Number	:	718-541-1449

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	04/25/2008

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