Provider Demographics
NPI:1609874353
Name:CORNEAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:CORNEAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RAPUANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-928-3180
Mailing Address - Street 1:840 WALNUT ST
Mailing Address - Street 2:STE 920
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-928-3180
Mailing Address - Fax:215-928-3854
Practice Address - Street 1:840 WALNUT ST
Practice Address - Street 2:STE 920
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3180
Practice Address - Fax:215-928-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041715E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007630360003Medicaid
PA51614Medicare PIN
PA051614Medicare PIN
NJ082199Medicare PIN