Basic Information
Provider Information | |||||||||
NPI: | 1023367406 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COREY W HUNTER, MD PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | AINSWORTH PAIN | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 270 | ||||||||
Address2: |   | ||||||||
City: | MASSAPEQUA PARK | ||||||||
State: | NY | ||||||||
PostalCode: | 117620270 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6312642035 | ||||||||
FaxNumber: | 6312641418 | ||||||||
Practice Location | |||||||||
Address1: | 115 E 57TH ST | ||||||||
Address2: | SUITE 1210 | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100222032 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2122032813 | ||||||||
FaxNumber: | 6466079061 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2012 | ||||||||
LastUpdateDate: | 03/18/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HUNTER | ||||||||
AuthorizedOfficialFirstName: | COREY | ||||||||
AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
AuthorizedOfficialTitleorPosition: | PHYSICIAN OWNER | ||||||||
AuthorizedOfficialTelephone: | 3053024552 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X |   | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.