Basic Information
| Provider Information | |||||||||
| NPI: | 1881832780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORENIS | ||||||||
| FirstName: | PANAGIOTA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1276 FULTON AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104563402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144265127 | ||||||||
| FaxNumber: | 7189018656 | ||||||||
| Practice Location | |||||||||
| Address1: | 1879 MADISON AVE | ||||||||
| Address2: | NORTH GENERAL HOSPITAL | ||||||||
| City: | MANHATTAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124234646 | ||||||||
| FaxNumber: | 2124234095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2009 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | AH185569756 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 266405 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 266405 | 01 | NY | NYS MEDICAL LICENSE | OTHER |