Provider Demographics
NPI:1699116129
Name:MOREAU, COURTNEY JO LINA (PA)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:JO LINA
Last Name:MOREAU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:JO LINA
Other - Last Name:STELLWAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:72 MAILLER AVE
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1337
Mailing Address - Country:US
Mailing Address - Phone:845-220-8982
Mailing Address - Fax:
Practice Address - Street 1:400 WESTAGE BUSINESS CTR DR
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2223
Practice Address - Country:US
Practice Address - Phone:845-765-0125
Practice Address - Fax:845-765-0128
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016627-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical