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1386303550
GRANT DALE-DERKS
BRONX, NY
NPI
1386303550
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Other Name
GRANT DALE DERKS
Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2021-12-14
Last Update Date
2024-01-30
Business Address
GRANT DALE-DERKS DO
4422 3RD AVE
BRONX, NY 10457-2545
Phone number: 718-960-9000
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Mailing Address
GRANT DALE-DERKS DO
333 HUGUENOT ST APT P112
NEW ROCHELLE, NY 10801-7350
Phone number: 636-541-8934
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