Individual
MRS. IDALIE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
84 SCHAEFER ST, BROOKLYN, NY 11207-1024
(917) 805-5594
Mailing address
84 SCHAEFER ST, BROOKLYN, NY 11207-1024
(917) 805-5594
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
06/05/2013
Last updated
09/16/2019
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