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General NPI Number Information
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NPI Number | 1003034141
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Entity Type | Individual
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Provider Name | KRISTY SELVAGGI RPAC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 1000 MONTAUK HIGHWAY GOOD SAMARITAN HOSPITAL
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City | WEST ISLIP
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State | NY
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Zip | 11795
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Country | US
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Telephone | 631-376-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 23 ACORN LANE
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City | STONY BROOK
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State | NY
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Zip | 11790
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Country | US
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Telephone | 631-807-2568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010787
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License Number State | NY
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