MEDICARE: MISS TONI LEIGH CORSELLO

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	174400000X	Specialist	702681131	NY
2	252Y00000X	Early Intervention Provider Agency	702681131	NY

General Provider Information

NPI Number	:	1437499191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TONI LEIGH CORSELLO

Provider Business Mailing Address
First Line	:	153 BEACH 124TH ST
Second Line	:
City	:	BELLE HARBOR
State	:	NY
Zip	:	11694-1338
Country	:	US
Telephone Number	:	917-567-6353
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 BEACH 124TH ST
Second Line	:
City	:	BELLE HARBOR
State	:	NY
Zip	:	11694-1839
Country	:	US
Telephone Number	:	917-567-6353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2013
Last Update Date	:	02/19/2013

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Directions to “ MISS TONI LEIGH CORSELLO ” Practice Location

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