Individual
KELLY JOY HUNTER CORNELIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 HOSPITAL RD, PATCHOGUE, NY 11772-4870
(631) 228-5801
Mailing address
25 BAYVIEW AVE, EAST SETAUKET, NY 11733-3933
(631) 260-0652
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
032959
NY
Other
Enumeration date
01/03/2025
Last updated
01/03/2025
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