Individual
DWIGHT SHELDON JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
24123 148TH AVE, ROSEDALE, NY 11422-3265
(718) 723-1083
(718) 723-1083
Mailing address
24123 148TH AVE, ROSEDALE, NY 11422-3265
(718) 723-1083
(718) 723-1083
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
548498
NY
Other
Enumeration date
06/03/2008
Last updated
06/03/2008
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