Healthcare Provider Details

I. General information

NPI: 1063156537
Provider Name (Legal Business Name): COLE CORICA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ALLISON DR
CHERRY HILL NJ
08003-2309
US

IV. Provider business mailing address

746 ALEXANDER RD
PRINCETON NJ
08540-6305
US

V. Phone/Fax

Practice location:
  • Phone: 856-827-7630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58433
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: