Provider Demographics
NPI:1508293762
Name:WESLEY, DABNEY GENERAL III
Entity Type:Individual
Prefix:MR
First Name:DABNEY
Middle Name:GENERAL
Last Name:WESLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 RIDGE HILL BLVD
Mailing Address - Street 2:APT 2J
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-7708
Mailing Address - Country:US
Mailing Address - Phone:914-575-8976
Mailing Address - Fax:
Practice Address - Street 1:701 RIDGE HILL BLVD
Practice Address - Street 2:APT 2J
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-7708
Practice Address - Country:US
Practice Address - Phone:914-575-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY393449677172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver