Provider Demographics
NPI:1861691792
Name:FURNARI, CORINNE LEE (PA CCN)
Entity type:Individual
Prefix:MS
First Name:CORINNE
Middle Name:LEE
Last Name:FURNARI
Suffix:
Gender:F
Credentials:PA CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 7TH AVE # 167
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4113
Mailing Address - Country:US
Mailing Address - Phone:212-608-1136
Mailing Address - Fax:
Practice Address - Street 1:250 W 49TH ST STE 503
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7433
Practice Address - Country:US
Practice Address - Phone:212-586-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002837-1133VN1006X
NY0034071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic