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General NPI Number Information
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NPI Number | 1013198704
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Entity Type | Organization
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Legal Business Name | BM VASCULAR SURGERY PC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 7554 METROPOLITAN AVE
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-2639
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Country | US
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Telephone | 516-220-6995
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Fax |
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Provider Business Mailing Address
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Address Line | 170 STIRRUP LN
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City | SYOSSET
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State | NY
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Zip | 11791-4417
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Country | US
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Telephone | 516-220-6995
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | MOHAN R BADHEY
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Credential |
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Telephone | 516-220-6995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 63766
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License Number State | NY
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