Individual
MR. DEITRON L DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 MALCOLM X BLVD FRNT A, NEW YORK, NY 10026-3021
(888) 493-3488
Mailing address
1915 SEAGIRT BLVD APT 11L, FAR ROCKAWAY, NY 11691-3786
(646) 956-7916
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
591190737
NY
Other
Enumeration date
02/25/2022
Last updated
02/25/2022
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