Provider Demographics
NPI:1366617763
Name:PAUL A. CORLEY, M.D., P.C.
Entity type:Organization
Organization Name:PAUL A. CORLEY, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-541-1449
Mailing Address - Street 1:11064 QUEENS BLVD
Mailing Address - Street 2:#129
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6347
Mailing Address - Country:US
Mailing Address - Phone:718-541-1449
Mailing Address - Fax:718-712-3343
Practice Address - Street 1:1 CROSS ISLAND PLZ
Practice Address - Street 2:SUITE 220A
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-1484
Practice Address - Country:US
Practice Address - Phone:718-541-1449
Practice Address - Fax:718-712-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1745622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000196040101OtherHEALTH PLUS
P2491206OtherOXFORD
NY522BA1OtherEMPIRE BC/BS
363784OtherMHN
7353654OtherVALUE OPTIONS
NY01757693Medicaid
NY330553OtherCMS WELLCARE
7353654OtherVALUE OPTIONS
06L881Medicare PIN