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Individual

EDWIN SAMUEL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
21837 103RD AVE, QUEENS VILLAGE, NY 11429-2001
(702) 353-8875
Mailing address
21837 103RD AVE, QUEENS VILLAGE, NY 11429-2001
(702) 353-8875

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
NY

Other

Enumeration date
10/10/2024
Last updated
10/10/2024
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