Provider Demographics
NPI:1053553388
Name:CORONA GYNECOLOGICAL MEDICAL SERVICES, PC
Entity type:Organization
Organization Name:CORONA GYNECOLOGICAL MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-779-2666
Mailing Address - Street 1:10408 ROOSEVELT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2328
Mailing Address - Country:US
Mailing Address - Phone:718-779-2666
Mailing Address - Fax:718-779-6006
Practice Address - Street 1:10408 ROOSEVELT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2328
Practice Address - Country:US
Practice Address - Phone:718-779-2666
Practice Address - Fax:718-779-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092267207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty