Provider Demographics
NPI:1588127120
Name:CORREA, PATRICK NORRIS (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:NORRIS
Last Name:CORREA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:55 N GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4955
Mailing Address - Country:US
Mailing Address - Phone:732-450-0961
Mailing Address - Fax:732-530-0213
Practice Address - Street 1:55 N GILBERT ST STE 3201
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4958
Practice Address - Country:US
Practice Address - Phone:732-450-0961
Practice Address - Fax:732-530-0213
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MB11313100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program