Provider Demographics
NPI:1235287079
Name:CORNELIUS, CYNTHIA JEANNE (DPM)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JEANNE
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:JEANNE
Other - Last Name:VONWNUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:246 FEDERAL RD
Mailing Address - Street 2:STE C21
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2647
Mailing Address - Country:US
Mailing Address - Phone:203-740-8637
Mailing Address - Fax:203-740-8750
Practice Address - Street 1:246 FEDERAL RD
Practice Address - Street 2:STE C21
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2647
Practice Address - Country:US
Practice Address - Phone:203-740-8637
Practice Address - Fax:203-740-8750
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004611213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT91426Medicare UPIN
CT4902110001Medicare NSC