Organization
ELLICOTTVILLE MEDICAL
Active
Organization
ELLICOTTVILLE MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATELYN JOHNSON-CLARK DO (OWNER)
(941) 441-7804
Entity
Organization
Contact information
Practice address
5 PARK SQ, ELLICOTTVILLE, NY 14731-7014
(716) 257-4397
Mailing address
PO BOX 1252, ELLICOTTVILLE, NY 14731-1252
(716) 257-4397
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
261977
NYS MEDICAL LICENSE NUMBER
NY
Enumeration date
12/21/2021
Last updated
12/21/2021
Update your record
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