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General NPI Number Information
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NPI Number | 1043485329
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Entity Type | Individual
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Provider Name | OLUYOMI EDITH AJISE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 1275 YORK AVE
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City | NEW YORK
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State | NY
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Zip | 10065-6007
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Country | US
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Telephone | 212-639-5696
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 WAYNE AVE APARTMENT 16J
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City | BRONX
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State | NY
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Zip | 10467-2510
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Country | US
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Telephone | 646-709-2250
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 01070299A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | P69842
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License Number State | NY
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