Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 40496 | SC |
N | 207PE0004X | Emergency Medical Services | 25MA09858600 | NJ |
NPI | 1205179058 |
---|---|
Provider Name | Steven Alexander Kornweiss |
First Address | Vineland, NJ 08360-7059 |
Second Address | Vineland, NJ 08360-7059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2013 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
404967 | (05) | SC |
SCA0398510 | MEDICARE PIN (01) | SC |
SCA0399068 | MEDICARE PIN (01) | SC |