Individual
DR. PHILIP CORSELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
354 VETS HWY, COMMACK, NY 11725
(631) 543-5319
Mailing address
354 VETS HWY, COMMACK, NY 11725
(631) 543-5319
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
006241
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00488413
—
NY
Enumeration date
05/23/2006
Last updated
05/07/2008
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