MEDICARE: DR. ALEXIS CORAZON MD

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	207RI0200X	Infectious Disease Physician	MA63961	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770552614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS CORAZON MD

Provider Business Mailing Address
First Line	:	355 TOTOWA AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07502-2125
Country	:	US
Telephone Number	:	973-389-1300
Fax Number	:	973-389-0138

Provider Business Practice Location Address
First Line	:	355 TOTOWA AVE
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07502-2125
Country	:	US
Telephone Number	:	973-389-1300
Fax Number	:	973-389-0138

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/23/2008

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