Provider Demographics
NPI:1447219191
Name:GEHEGAN, CORINNE JEANETTE (DPM)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:JEANETTE
Last Name:GEHEGAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 BOULEVARD EAST
Mailing Address - Street 2:#12E
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-4818
Mailing Address - Country:US
Mailing Address - Phone:917-674-0074
Mailing Address - Fax:
Practice Address - Street 1:725 RIVER ROAD
Practice Address - Street 2:SUITE 201-A
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020
Practice Address - Country:US
Practice Address - Phone:201-840-7373
Practice Address - Fax:201-840-7383
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00272100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ078809M78Medicare ID - Type Unspecified
U99755Medicare UPIN