Provider Demographics
NPI:1437160504
Name:LA CORTE, MEENAKSHI (MD)
Entity type:Individual
Prefix:DR
First Name:MEENAKSHI
Middle Name:
Last Name:LA CORTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEENAKSHI
Other - Middle Name:
Other - Last Name:GULRAJANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:31 HYLAN BLVD
Mailing Address - Street 2:APT 11D
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2000
Mailing Address - Country:US
Mailing Address - Phone:718-720-1829
Mailing Address - Fax:718-720-1829
Practice Address - Street 1:699 92ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3619
Practice Address - Country:US
Practice Address - Phone:718-567-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1412982080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00711106Medicaid
NYB19117Medicare UPIN
NY00711106Medicaid