Individual
MR. SAMUEL DEADWYLER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1350 BEDFORD AVE APT 3M, BROOKLYN, NY 11216-5804
(516) 451-4155
Mailing address
1350 BEDFORD AVE APT 3M, BROOKLYN, NY 11216-5804
(516) 451-4155
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
511051614
NY
Other
Enumeration date
01/11/2024
Last updated
01/11/2024
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