Provider Demographics
NPI:1104872225
Name:DECOTEAU, KORDAI I (DPM)
Entity type:Individual
Prefix:
First Name:KORDAI
Middle Name:I
Last Name:DECOTEAU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EDGEWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901
Mailing Address - Country:US
Mailing Address - Phone:973-395-1550
Mailing Address - Fax:973-395-1556
Practice Address - Street 1:60 EVERGREEN PLACE
Practice Address - Street 2:SUITE 400
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-395-1550
Practice Address - Fax:973-395-1556
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005951 1213E00000X
NJ25MD00333900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist