Provider Demographics
NPI:1497649925
Name:CORNIELLE, ROBERTO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:CORNIELLE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:ROBERTO
Other - Middle Name:
Other - Last Name:CORNIELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ROBERTO CORNIELLE
Mailing Address - Street 1:407 E 30TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07504-1635
Mailing Address - Country:US
Mailing Address - Phone:201-790-7943
Mailing Address - Fax:
Practice Address - Street 1:407 E 30TH ST # 2
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1635
Practice Address - Country:US
Practice Address - Phone:201-790-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02322400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist