Provider Demographics
NPI:1912392192
Name:ENNIS, COREY E (PA)
Entity Type:Individual
Prefix:MRS
First Name:COREY
Middle Name:E
Last Name:ENNIS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:1184 STATE ROUTE 50
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1923
Practice Address - Country:US
Practice Address - Phone:518-384-1281
Practice Address - Fax:518-384-0321
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2022-10-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant