Healthcare Provider Details

I. General information

NPI: 1811829005
Provider Name (Legal Business Name): JOSHUA CORNELIUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MAIN ST
BETHLEHEM PA
18018-6614
US

IV. Provider business mailing address

407 NEW JERSEY RD
BROWNS MILLS NJ
08015-5440
US

V. Phone/Fax

Practice location:
  • Phone: 610-861-1320
  • Fax:
Mailing address:
  • Phone: 609-864-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: