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General NPI Number Information
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NPI Number | 1033512843
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Entity Type | Organization
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Legal Business Name | MOUNT VERNON MEDICAL PRACTICE
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 175 MEMORIAL HWY SUITE 1-4
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5635
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Country | US
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Telephone | 914-633-5700
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Fax | 914-633-0446
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Provider Business Mailing Address
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Address Line | 175 MEMORIAL HWY SUITE 1-4
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-5635
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Country | US
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Telephone | 914-633-5700
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Fax | 914-633-0446
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Authorized Official
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Title or Position | FNP-C
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Name | MS. CARMEN MENDEZ
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Credential | FNP
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Telephone | 646-207-9934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | F338574-1
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License Number State | NY
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