Provider Demographics
NPI:1588878540
Name:CORRIGAN, JENNIFER ANNE (LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 HORTON HWY
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2520
Mailing Address - Country:US
Mailing Address - Phone:516-873-0822
Mailing Address - Fax:
Practice Address - Street 1:2421 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1320
Practice Address - Country:US
Practice Address - Phone:516-766-1717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist