Provider Demographics
NPI:1922029842
Name:PETER M CORRADO PC
Entity Type:Organization
Organization Name:PETER M CORRADO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-463-9960
Mailing Address - Street 1:108 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2190
Mailing Address - Country:US
Mailing Address - Phone:609-463-9960
Mailing Address - Fax:609-463-9980
Practice Address - Street 1:108 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2190
Practice Address - Country:US
Practice Address - Phone:609-463-9960
Practice Address - Fax:609-463-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB49801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080171611OtherRAILROAD MEDICARE
NJ0868042001OtherKEYSTONE MERCY HEALTH PLN
NJ2494809Medicaid
NJP2522550OtherOXFORD
NJ1140431OtherHORIZON MERCY HEALTH PLAN
NJ0868042001OtherAMERIHEALTH
NJ2539071OtherAETNA US HEALTHCARE
NJ2494809Medicaid
NJ0868042001OtherAMERIHEALTH
NJ=========OtherTRICARE / CHAMPUS
NJ1140431OtherHORIZON MERCY HEALTH PLAN
NJ=========OtherUNITED HEALTHCARE
NJ2539071OtherAETNA US HEALTHCARE
NJ=========OtherTRICARE / CHAMPUS