Individual
THEODORE G KOERNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4911 BLACK HORSE PIKE (RT 42), TURNERSVILLE, NJ 08012-1730
(856) 227-7048
Mailing address
PO BOX 1107, TURNERSVILLE, NJ 08012-0877
(856) 227-7048
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MB031874
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0073996001
AMERIHEALTH NJ
NJ
05
—
2191105
—
NJ
01
—
5433019
AETNA
—
Enumeration date
09/14/2005
Last updated
07/08/2007
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