Provider Demographics
NPI:1467472662
Name:CORNERSTONE PHYSICAL THERAPY
Entity type:Organization
Organization Name:CORNERSTONE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA FUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:732-499-4540
Mailing Address - Street 1:P.O. BOX 106
Mailing Address - Street 2:
Mailing Address - City:TRANQUILITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07879
Mailing Address - Country:US
Mailing Address - Phone:908-684-1241
Mailing Address - Fax:908-684-4039
Practice Address - Street 1:35-B KENNEDY ROAD
Practice Address - Street 2:
Practice Address - City:TRANQUILITY
Practice Address - State:NJ
Practice Address - Zip Code:07879
Practice Address - Country:US
Practice Address - Phone:908-684-1241
Practice Address - Fax:908-684-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01170400225100000X
NJ40QA00944300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071368RXCMedicare PIN
NJ071361Medicare PIN