Active NPI
Jorge Luis Cornielle, MD
- Pediatrics Physician
- Bronx, NY
National Provider Identifier
1255408365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 214716
- Practice address
- 1262 Boston Rd
Bronx, NY 10456-3602 - Phone
- (718) 617-2500
- Fax
- (718) 617-0500
- NPI assigned
- Nov 30, 2006
- Last updated
- Dec 8, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 214716 | NY | Primary |
Addresses
Primary practice location
1262 Boston Rd
Bronx, NY 10456-3602
Mailing address
102 Princeton Dr
Tappan, NY 10983-1026
Phone (845) 398-3043
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02087341 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BRMC Medical PLLC | Current | Accepting new patients |
Locations
1262 Boston Rd
Bronx, NY 10456
Phone (718) 569-7929
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H3359
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Specialist
- Bronx, NY
- NPI 1629358908
-
- Pediatrics Physician
- Bronx, NY
- NPI 1275724767
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323302400000",
"number": "1255408365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102 PRINCETON DR",
"city": "TAPPAN",
"state": "NY",
"postal_code": "109831026",
"telephone_number": "845-398-3043"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1262 BOSTON RD",
"city": "BRONX",
"state": "NY",
"postal_code": "104563602",
"telephone_number": "718-617-2500",
"fax_number": "718-617-0500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORNIELLE",
"first_name": "JORGE",
"middle_name": "LUIS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2011-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "214716",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02087341",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.