Basic Information
| Provider Information | |||||||||
| NPI: | 1720594229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FILLMAN | ||||||||
| FirstName: | CORRINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCGC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 453 | ||||||||
| Address2: | |||||||||
| City: | ELMWOOD PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074070453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8334363832 | ||||||||
| FaxNumber: | 2016056582 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 BISCAYNE BLVD | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8334363832 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2017 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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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 | 170300000X | 000205 | OH | N | Other Service Providers | Genetic Counselor, MS | 170300000X | 25MJ00017700 | NJ | N | Other Service Providers | Genetic Counselor, MS | 170300000X | 246.000236 | IL | N | Other Service Providers | Genetic Counselor, MS | 170300000X | GC000677 | CA | N | Other Service Providers | Genetic Counselor, MS | 170300000X | GC000101 | PA | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.