Basic Information
| Provider Information | |||||||||
| NPI: | 1295930352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KORIN | ||||||||
| FirstName: | MARY ANNE | ||||||||
| MiddleName: | - | ||||||||
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| Credential: | CPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32 E BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | MAHOPAC | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105413223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456286826 | ||||||||
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| Practice Location | |||||||||
| Address1: | 584 N STATE RD | ||||||||
| Address2: | |||||||||
| City: | BRIARCLIFF MANOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105101522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147622222 | ||||||||
| FaxNumber: | 9147629175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 004815-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.