Individual
CORINNE CRAIG PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2280 N OCEAN AVE, FARMINGVILLE, NY 11738-2911
(631) 698-7828
(631) 698-3300
Mailing address
1345 RXR PLZ FL 13, UNIONDALE, NY 11556-1301
(516) 453-0435
(646) 846-3283
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
017900
NY
363AM0700X
Medical Physician Assistant
017900
NY
363AS0400X
Surgical Physician Assistant
017900
NY
Other
Enumeration date
08/21/2014
Last updated
12/06/2019
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