Provider Demographics
NPI:1639147663
Name:CORNELL, STEVEN J (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:CORNELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 HOOKER AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3631
Mailing Address - Country:US
Mailing Address - Phone:845-485-5700
Mailing Address - Fax:845-485-5701
Practice Address - Street 1:387 HOOKER AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3631
Practice Address - Country:US
Practice Address - Phone:845-485-5700
Practice Address - Fax:845-485-5701
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003227213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635227-2Medicaid
NYP34791Medicare ID - Type UnspecifiedPRIMARY LOCATION
NY00635227-2Medicaid
NYP34792Medicare ID - Type UnspecifiedSECONDARY LOCATION