Individual
LANCE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
30 THORNTON ST, BROOKLYN, NY 11206-4416
(646) 801-0634
Mailing address
3 SAINT JOHNS RD, RIDGEWOOD, NY 11385-2340
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
172V00000X
Community Health Worker
—
—
174H00000X
Health Educator
—
—
Other
Enumeration date
08/07/2019
Last updated
08/07/2019
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