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General NPI Number Information
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NPI Number | 1003270224
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Entity Type | Individual
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Provider Name | PETER REZNIK
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Gender | Male
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Dates
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Enumeration Date | 04/13/2016
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 1641 3RD AVE STE 201
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City | NEW YORK
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State | NY
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Zip | 10128-3623
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Country | US
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Telephone | 973-572-9972
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Fax |
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Provider Business Mailing Address
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Address Line | 11050 71ST RD APT 8E
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City | FOREST HILLS
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State | NY
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Zip | 11375-4970
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Country | US
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Telephone | 973-572-9972
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 070359-1
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License Number State | NY
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