Individual
CASEY GRACE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
27005 76TH AVE, NEW HYDE PARK, NY 11040-1402
(718) 470-7500
Mailing address
87 W ISLIP RD, WEST ISLIP, NY 11795-4553
(631) 357-1312
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
020461
NY
Other
Enumeration date
12/05/2016
Last updated
07/11/2022
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