Individual
CODY CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1401 SUMMIT DR, NEWARK, NY 14513-8904
(585) 683-9308
Mailing address
1401 SUMMIT DR, NEWARK, NY 14513-8904
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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