Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | F350268 | NY |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | F350268 | NY |
NPI | 1215154463 |
---|---|
Provider Name | Janette Corallo |
First Address | Bellmore, NY 11710-0278 |
Second Address | New York, NY 10032-1559 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 19/10/2009 |