Provider Demographics
NPI:1366768343
Name:CORBIN, KATHLEEN JO ELAYDA
Entity type:Individual
Prefix:
First Name:KATHLEEN JO
Middle Name:ELAYDA
Last Name:CORBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN JO
Other - Middle Name:FLORES
Other - Last Name:ELAYDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 CEDAR ST
Mailing Address - Street 2:P.O. BOX 208064
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3206
Mailing Address - Country:US
Mailing Address - Phone:203-688-2475
Mailing Address - Fax:203-785-3932
Practice Address - Street 1:330 CEDAR ST
Practice Address - Street 2:DCB 14
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3218
Practice Address - Country:US
Practice Address - Phone:203-688-2475
Practice Address - Fax:203-785-3932
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT557872080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology