Provider Demographics
NPI:1619227543
Name:CAROL C. CORNFELDT, CNS, PA
Entity Type:Organization
Organization Name:CAROL C. CORNFELDT, CNS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE PRACTITIONE
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CORNFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:CNS
Authorized Official - Phone:973-292-1890
Mailing Address - Street 1:20 COMMUNITY PL
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7500
Mailing Address - Country:US
Mailing Address - Phone:973-292-1890
Mailing Address - Fax:973-539-3687
Practice Address - Street 1:20 COMMUNITY PL
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7500
Practice Address - Country:US
Practice Address - Phone:973-292-1890
Practice Address - Fax:973-539-3687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC03405800364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ753124Medicare UPIN