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General NPI Number Information
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NPI Number | 1033797386
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Entity Type | Organization
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Legal Business Name | MICHELE AHMADI D.P.M. L.L.C.
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 257 E MAIN ST STE C
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City | SMITHTOWN
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State | NY
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Zip | 11787-2807
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Country | US
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Telephone | 631-982-9343
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Fax |
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Provider Business Mailing Address
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Address Line | 45 ELWOOD RD
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City | NORTHPORT
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State | NY
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Zip | 11768-3416
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Country | US
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Telephone | 732-735-7847
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELE AHMADI
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Credential | DPM
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Telephone | 732-735-7847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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