Most Relevant Information
Provider Data
| NPI Number: | 1003694589 |
| Provider Name: | CORY DODGE |
| Entity Type: | Individual |
| Taxonomy Code: | 246ZE0600X |
| Specialty: | Specialist/Technologist, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/18/2023 |
| Last Updated: | 09/18/2023 |
Provider Practice Location
314 EVERGREEN AVE APT 4B
BROOKLYN
NY
112218352
Practice Location Phone/Fax
| Phone: | 6319745446 |
| Fax: |
Provider Mailing Location
314 EVERGREEN AVE APT 4B
BROOKLYN
NY
112218352
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |