Individual
COURTNEY MALIA CLEMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 HEROES WAY, RIVERHEAD, NY 11901-2058
(631) 548-6000
Mailing address
1 HEROES WAY, RIVERHEAD, NY 11901-2058
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
032654
NY
Other
Enumeration date
05/27/2024
Last updated
09/30/2024
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