NPI 1063168276

Deitron L Davis

Practitioner Driver New York, NY

Practice location

Address: 55 Malcolm X Blvd Frnt a, New York, NY 10026-3021
Phone: (888) 493-3488
Mailing address: 1915 Seagirt Blvd APT 11l, Far Rockaway, NY 11691-3786

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 591190737 (NY)

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Registry record

NPI: 1063168276
Entity type: Individual
Sex (as registered): Male
NPI issued: 25 Feb 2022
Record last updated: 25 Feb 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.