Healthcare Provider Details

I. General information

NPI: 1023376647
Provider Name (Legal Business Name): DANIELLE M CORPUZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WATCHUNG AVE
CHATHAM NJ
07928-2700
US

IV. Provider business mailing address

17 WATCHUNG AVE
CHATHAM NJ
07928-2700
US

V. Phone/Fax

Practice location:
  • Phone: 973-665-0900
  • Fax: 973-665-0901
Mailing address:
  • Phone: 973-665-0900
  • Fax: 973-665-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA10020700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: