Provider Demographics
NPI:1538236716
Name:CORONA, EUNICE VICTORIA (PA)
Entity type:Individual
Prefix:MISS
First Name:EUNICE
Middle Name:VICTORIA
Last Name:CORONA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W 114TH ST
Mailing Address - Street 2:MUL2 SECTION D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1796
Mailing Address - Country:US
Mailing Address - Phone:212-523-4799
Mailing Address - Fax:212-523-1761
Practice Address - Street 1:440 W 114TH ST
Practice Address - Street 2:MUL2 SECTION D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1796
Practice Address - Country:US
Practice Address - Phone:212-523-4799
Practice Address - Fax:212-523-1761
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01854282Medicaid
NY331951Medicare ID - Type Unspecified