Basic Information
| Provider Information | |||||||||
| NPI: | 1164814315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LECORPS | ||||||||
| FirstName: | SIENA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 36363 NEWARK NJ 07188 PHONE | ||||||||
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| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071880001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456511400 | ||||||||
| FaxNumber: | 8452943758 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 HATFIELD LN STE 208 | ||||||||
| Address2: | |||||||||
| City: | GOSHEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109246768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452940994 | ||||||||
| FaxNumber: | 8452948622 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2015 | ||||||||
| LastUpdateDate: | 03/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 345539 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.