Provider Demographics
NPI:1174736193
Name:CORRALES, MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CORRALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRYENS DR
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-4912
Mailing Address - Country:US
Mailing Address - Phone:551-208-1778
Mailing Address - Fax:
Practice Address - Street 1:235 SHORE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2631
Practice Address - Country:US
Practice Address - Phone:609-926-9400
Practice Address - Fax:609-926-4177
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA008278200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0144916Medicaid