Juan Carlos Cornejo, DO

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

25MB08477000 Issued in NJ

Practice address

113 White Horse Rd W
Suite 7
Voorhees, NJ 08043-3672

Phone

(856) 552-2208

Fax

(856) 283-3158

NPI assigned

May 19, 2008

Last updated

Feb 19, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Momentum Medicine Plus LLC

  • Sports Medicine (Family Medicine) Physician
  • Voorhees, NJ
  • NPI 1023433604
  Authorized official Same address or phone
• TPS III of PA, LLC

  dba Hahnemann Primary Services

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1902841018
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392768000000",
    "number": "1952568974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 WHITE HORSE RD W",
            "address_2": "SUITE 7",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080433672",
            "telephone_number": "856-552-2208",
            "fax_number": "856-283-3158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 WHITE HORSE RD W",
            "address_2": "SUITE 7",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080433672",
            "telephone_number": "856-552-2208",
            "fax_number": "856-283-3158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNEJO",
        "first_name": "JUAN",
        "middle_name": "CARLOS",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-19",
        "last_updated": "2014-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "NJ",
            "license": "25MB08477000",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MD",
            "license": "H0072462",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "VA",
            "license": "0102202824",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "PA",
            "license": "OS014255",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Cooper, APN
• Ebonie T Copeland
• Marjorie Anne Copeland, LCSW
• Core Counseling South Jersey, LLC
• Sean P Corey, APN
• Kelleen Corrigan, BCBA
• Sarah Elaine Corrington
• Savannah Corsey
• Alexa Marie Corso, DO
• Bernard J Cortese, M.D.

• Sports Medicine (Family Medicine) Physician in Voorhees, NJ
• Providers in Voorhees, NJ by specialty
• Sports Medicine (Family Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.