Provider Demographics
NPI:1730235292
Name:CORNFELDT, CAROL C (APN PA)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:C
Last Name:CORNFELDT
Suffix:
Gender:F
Credentials:APN PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 COMMUNITY PLACE
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:973-292-1890
Mailing Address - Fax:973-539-3687
Practice Address - Street 1:20 COMMUNITY PLACE
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-292-1890
Practice Address - Fax:973-539-3687
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NC03405800364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ753124Medicare ID - Type Unspecified