Provider Demographics
NPI:1144499781
Name:ANTHONY J. CORDISCO, DPM
Entity type:Organization
Organization Name:ANTHONY J. CORDISCO, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORDISCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-386-7807
Mailing Address - Street 1:1105 SUNSET RD
Mailing Address - Street 2:COOPERTOWN PLAZA
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2290
Mailing Address - Country:US
Mailing Address - Phone:609-386-7807
Mailing Address - Fax:
Practice Address - Street 1:1105 SUNSET RD
Practice Address - Street 2:COOPERTOWN PLAZA
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-2290
Practice Address - Country:US
Practice Address - Phone:609-386-7807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00157400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2169703Medicaid
NJ4424720001Medicare NSC
NJ2169703Medicaid