Provider Demographics
NPI:1285491977
Name:CKG NURSE PRACTITIONER IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:CKG NURSE PRACTITIONER IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GONERA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:917-765-2009
Mailing Address - Street 1:16 MADISON SQ W FL 12
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1629
Mailing Address - Country:US
Mailing Address - Phone:917-765-2009
Mailing Address - Fax:
Practice Address - Street 1:16 MADISON SQ W FL 12
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-1629
Practice Address - Country:US
Practice Address - Phone:917-765-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty