Provider Demographics
NPI:1699765354
Name:NORDONE, DANIELLE S (DO)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:S
Last Name:NORDONE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLAZA
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:
Practice Address - Street 1:3156 RIVER ROAD
Practice Address - Street 2:COOPER FAMILY MEDICINE, PC
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105
Practice Address - Country:US
Practice Address - Phone:856-356-4988
Practice Address - Fax:856-365-0279
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0007502207Q00000X
NJMB07867200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01004660700OtherAMERICHOICE
NJ4991853OtherCIGNA
NJ0167665Medicaid
NJ3530913000OtherAMERIHEALTH/KEYSTONE/IBC
NJ60041544OtherHORIZON NJ HEALTH
NJ7377801OtherAETNA
DE1000038452Medicaid
NJP3922124OtherOXFORD
NJ7377801OtherAETNA
NJ4991853OtherCIGNA
NJ3530913000OtherAMERIHEALTH/KEYSTONE/IBC
DEI48021Medicare UPIN
DE081802Medicare Oscar/Certification