Individual
CODY EVAN WHITNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
17 MILLER ROAD, CROWN POINT, NY 12928-2530
(518) 597-3029
Mailing address
PO BOX 277, ELIZABETHTOWN, NY 12932-0277
(518) 873-9000
(518) 873-2314
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
021661
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021661
NY LICENSE
NY
Enumeration date
11/27/2017
Last updated
03/17/2018
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