1396196721 NPI number — CORNERSTONE FOOT & ANKLE

Table of content: DR. STEPHEN PAUL BUCKLEW ND (NPI 1528472826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396196721 NPI number — CORNERSTONE FOOT & ANKLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE FOOT & ANKLE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396196721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 KINGS WAY E
Provider Second Line Business Mailing Address:
SUITE D6
Provider Business Mailing Address City Name:
SEWELL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08080-2237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-582-6082
Provider Business Mailing Address Fax Number:
856-582-6083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 MADISON AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT HOLLY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08060-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-582-6082
Provider Business Practice Location Address Fax Number:
856-582-6083
Provider Enumeration Date:
06/27/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAYLINSON
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMIN
Authorized Official Telephone Number:
856-582-6082

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)