MEDICARE: DR. PAUL ANTHONY CORLEY 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	2084P0800X	Psychiatry Physician	174562	NY

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
2	7334026	OTHER	NY	GROUP HEALTH INC
3	291673	OTHER	NY	MANAGED HEALTH NETWORK

General Provider Information

NPI Number	:	1821078460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ANTHONY CORLEY MD

Provider Business Mailing Address
First Line	:	11064 QUEENS BOULEVARD
Second Line	:	BOX 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	:	ONE CROSS ISLAND PLAZA
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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