Provider Demographics
NPI:1952568974
Name:CORNEJO, JUAN CARLOS (DO)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:CORNEJO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 WHITE HORSE RD W
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3672
Mailing Address - Country:US
Mailing Address - Phone:856-552-2208
Mailing Address - Fax:856-283-3158
Practice Address - Street 1:113 WHITE HORSE RD W
Practice Address - Street 2:SUITE 7
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3672
Practice Address - Country:US
Practice Address - Phone:856-552-2208
Practice Address - Fax:856-283-3158
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08477000207QS0010X
MDH0072462207QS0010X
VA0102202824207QS0010X
PAOS014255207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine