Provider Demographics
NPI:1902289044
Name:CORNICELLI, MARIE (MSED)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CORNICELLI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ACKERMAN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3443
Mailing Address - Country:US
Mailing Address - Phone:917-543-5640
Mailing Address - Fax:
Practice Address - Street 1:39 ACKERMAN ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3443
Practice Address - Country:US
Practice Address - Phone:917-543-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist