Individual
DWAN SCAFE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
53 LINDBERGH PL, POUGHKEEPSIE, NY 12603-1335
(845) 392-2989
Mailing address
53 LINDBERGH PL, POUGHKEEPSIE, NY 12603-1335
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
956614529
NY
Other
Enumeration date
09/01/2022
Last updated
09/01/2022
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