Individual
JOSHUA MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
380 FREEVILLE RD, FREEVILLE, NY 13068-9684
(607) 844-6275
Mailing address
178 N MAIN ST, MORAVIA, NY 13118-3514
(315) 730-1085
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00353562
—
NY
Enumeration date
01/21/2021
Last updated
01/21/2021
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