Provider Demographics
NPI:1104136472
Name:AYER, CORY C (LICENSED PROSTHETIST)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:C
Last Name:AYER
Suffix:
Gender:M
Credentials:LICENSED PROSTHETIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446
Mailing Address - Country:US
Mailing Address - Phone:201-825-1999
Mailing Address - Fax:
Practice Address - Street 1:209 PIERSON AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3139
Practice Address - Country:US
Practice Address - Phone:173-254-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPR00001500335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier