Provider Demographics
NPI:1669654273
Name:STEVEN J. CORNELL, DPM
Entity Type:Organization
Organization Name:STEVEN J. CORNELL, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-485-5700
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:845-876-7878
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:845-876-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003227332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635227Medicaid
NY00635227Medicaid
NY4699720002Medicare NSC
NYP34792Medicare PIN
NY4699720001Medicare NSC
NYT71181Medicare UPIN