Healthcare Provider Details

I. General information

NPI: 1316033426
Provider Name (Legal Business Name): CHARLES N. CORNELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4872
US

IV. Provider business mailing address

PO BOX 29234
NEW YORK NY
10087-9234
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1414
  • Fax: 212-774-2348
Mailing address:
  • Phone: 631-329-6925
  • Fax: 631-329-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number39238
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number039238
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number149220
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number149220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: