Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ardouin Coriolan

Individual provider Registered Nurse · NPI 1992234942

Ardouin Coriolan is a Nurse Practitioner in Deer Park, New York. Qualified in 2021, 5 years ago. Practices with Stony Brook Psychiatric Associates University Faculty Practice Corpor, a 101-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
5
Licensed in
NY
In the registry since
2017
Specialties on file
3
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Practice location Address checks out

770 Grand Blvd
Deer Park, NY 11729-5750
Phone: (631) 392-4357
Fax: (631) 364-9850
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 403554 (NY)
Registered Nurse Taxonomy 163W00000X · Licence 641751 (NY)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 341841 (NY)

Record details

NPI number1992234942
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 5, 2017
Last updated in NPPESAugust 2, 2025
Certification dateAugust 2, 2025
Mailing address124 Oakfield Ave, Dix Hills, NY 11746-8114

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Stony Brook Psychiatric Associates University Faculty Practice Corpor — 101 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Deer Park