Individual
KECIA DEPASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4410 MURDOCK AVENUE, BRONX, NY 10466
(718) 496-4408
Mailing address
4410 MURDOCK AVENUE, BRONX, NY 10466
(718) 496-4408
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
946714675
NY
Other
Enumeration date
08/03/2015
Last updated
08/03/2015
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