Provider Demographics
NPI:1124456660
Name:POLIMENI, COURTNEY
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:POLIMENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:WYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:56 EAST ST
Mailing Address - Street 2:
Mailing Address - City:EDMESTON
Mailing Address - State:NY
Mailing Address - Zip Code:13335-2405
Mailing Address - Country:US
Mailing Address - Phone:607-353-9891
Mailing Address - Fax:
Practice Address - Street 1:56 EAST ST
Practice Address - Street 2:
Practice Address - City:EDMESTON
Practice Address - State:NY
Practice Address - Zip Code:13335-2405
Practice Address - Country:US
Practice Address - Phone:607-353-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist