| Street | 2229 Rte 112 #1 | ||
| City/Town | Coram | ||
| State/Province/Region | New York | ||
| Zip/Postal Code | 11727 | ||
| Phone Number | (631) 736-7878 | ||
| Country | United States |
| Full Name | Dr. Raoul Haag I | ||
| Gender | male | ||
| Birthday | 1989-09-14 | ||
| Social Security Number | 534-71-4339 |
| Credit card brand | JCB | ||
| Credit card number | 3520646199014759 | ||
| Expire | 2027/9 | ||
| CVV | 957 |