Individual
WINWARD TERRY DALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3965 BELL AVE, BRONX, NY 10466-2432
(917) 995-7626
Mailing address
3965 BELL AVE, BRONX, NY 10466-2432
(917) 995-7626
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
1277672181
NY
Other
Enumeration date
03/15/2019
Last updated
03/15/2019
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