Provider Demographics
NPI:1114004645
Name:COROMILAS, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:COROMILAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1075
Mailing Address - Street 2:579A CRANBURY RD. UNIVERSITY RADIOLOG GROUP, PC
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:125 PATERSON ST
Practice Address - Street 2:SUITE #6100
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-235-7856
Practice Address - Fax:732-249-1208
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130192207RC0000X, 207RC0001X
NJ25MA08519800207RC0000X, 207RC0001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00607525Medicaid
NJ0195359Medicaid
NY00607525Medicaid
NJ152667ANUMedicare PIN
NYB15299Medicare UPIN
NJ0195359Medicaid
NY49A5138361Medicare PIN