Healthcare Provider Details

I. General information

NPI: 1447241633
Provider Name (Legal Business Name): LORRAINE CORNWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

703 MAIN ST
PATERSON NJ
07503-2621
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2486
  • Fax: 973-754-2975
Mailing address:
  • Phone: 973-754-2486
  • Fax: 973-754-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA77204
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: