Individual
BYRON ILLESCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
167B MAIN ST, BREWSTER, NY 10509-1537
(845) 279-1398
Mailing address
167B MAIN ST, BREWSTER, NY 10509-1537
(845) 279-1398
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
11/18/2019
Last updated
11/18/2019
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