Individual
NICOLE COURTENAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1 HEROES WAY, RIVERHEAD, NY 11901-2058
(631) 548-6000
Mailing address
386 FISHEL AVE, RIVERHEAD, NY 11901-4724
(631) 764-2347
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1231985
NY
Other
Enumeration date
02/12/2025
Last updated
02/12/2025
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