Basic Information
| Provider Information | |||||||||
| NPI: | 1437231123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORSARO | ||||||||
| FirstName: | LOUIS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 SOUTH BEDFORD RD | ||||||||
| Address2: | MOUNT KISCO MEDICAL GROUP PC | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142411050 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 BEDFORD RD | ||||||||
| Address2: | MOUNT KISCO MEDICAL GROUP PC | ||||||||
| City: | KATONAH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142323135 | ||||||||
| FaxNumber: | 9142421516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 11/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 103659 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | P00388710 | 01 | NY | MEDICARE RAILROAD | OTHER | 0667910001 | 01 | NY | DME | OTHER | 01034913 | 05 | NY | MEDICAID |