Most Relevant Information
Provider Data
| NPI Number: | 1003558552 |
| Provider Name: | JOSEPHINE LA CORTE |
| Entity Type: | Individual |
| Taxonomy Code: | 302R00000X |
| Specialty: | Health Maintenance Organization |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/13/2022 |
| Last Updated: | 04/13/2022 |
Provider Practice Location
445 OAK ST
COPIAGUE
NY
117263111
Practice Location Phone/Fax
| Phone: | 6312575173 |
| Fax: |
Provider Mailing Location
16 GARDEN PL
SHIRLEY
NY
119672208
Provider Mailing Phone/Fax
| Phone: | 6315766758 |
| Fax: |