Individual
DR. JORGE LUIS CORNIELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1262 BOSTON RD, BRONX, NY 10456-3602
(718) 617-2500
(718) 617-0500
Mailing address
102 PRINCETON DR, TAPPAN, NY 10983-1026
(845) 398-3043
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
214716
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02087341
—
NY
Enumeration date
11/30/2006
Last updated
12/08/2011
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