Individual
MRS. CASEY GREER COUSINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
40 RIDGEWAY BLVD, BAY SHORE, NY 11706-6333
(631) 647-7909
Mailing address
40 RIDGEWAY BLVD, BAY SHORE, NY 11706-6333
(631) 647-7909
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
130009
NY
Other
Enumeration date
07/19/2012
Last updated
07/19/2012
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