Provider Demographics
NPI:1144332198
Name:KORNRICH, WILLIAM J (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:KORNRICH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:887 OLD COUNTRY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2115
Mailing Address - Country:US
Mailing Address - Phone:631-727-6122
Mailing Address - Fax:631-727-2672
Practice Address - Street 1:887 OLD COUNTRY RD
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2115
Practice Address - Country:US
Practice Address - Phone:631-727-6122
Practice Address - Fax:631-727-2672
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-03-10
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Provider Licenses
StateLicense IDTaxonomies
NY182977207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01265916Medicaid
NYE76282Medicare UPIN
NY01265916Medicaid