Healthcare Provider Details

I. General information

NPI: 1487102778
Provider Name (Legal Business Name): CORNERSTONE FOOT & ANKLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N MAIN ST
GLASSBORO NJ
08028-1605
US

IV. Provider business mailing address

516 HIGH ST
MOUNT HOLLY NJ
08060-1026
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-6082
  • Fax: 856-582-6083
Mailing address:
  • Phone: 856-582-6082
  • Fax: 856-582-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WARKALA
Title or Position: OWNER
Credential: DPM
Phone: 856-582-6082