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General NPI Number Information
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NPI Number | 1285186379
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Entity Type | Organization
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Legal Business Name | DAWUD'S BARBER STYLING SALON
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 261 QUAIL ST
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City | ALBANY
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State | NY
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Zip | 12203-1218
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Country | US
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Telephone | 518-331-3967
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Fax |
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Provider Business Mailing Address
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Address Line | 261 QUAIL ST
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City | ALBANY
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State | NY
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Zip | 12203-1218
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Country | US
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Telephone | 518-331-3967
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Fax |
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Authorized Official
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Title or Position | CERTIFIED HAIR LOSS SPECIALIST
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Name | DAVID ELLERBE JR.
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Credential |
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Telephone | 518-209-0817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | AEC14009444
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License Number State | NY
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