Individual
COURTNEY GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
495 JACK MARTIN BLVD STE 2, BRICK, NJ 08724-7778
(732) 458-7575
Mailing address
46 CASTLE AVE, JACKSON, NJ 08527-2513
(732) 856-3558
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00873400
NJ
Other
Enumeration date
08/03/2024
Last updated
08/03/2024
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