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General NPI Number Information
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NPI Number | 1063501104
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Entity Type | Individual
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Provider Name | JAISHREE SUBRAMANI M.D,M.P.H
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 500 M0NTAUK HIGHWAY SUITE B
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City | WEST ISLIP
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State | NY
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Zip | 11795-1201
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Country | US
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Telephone | 631-422-4343
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Fax | 631-661-3775
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Provider Business Mailing Address
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Address Line | 500 M0NTAUK HIGHWAY SUITE B
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City | WEST ISLIP
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State | NY
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Zip | 11795-1201
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Country | US
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Telephone | 631-422-4343
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Fax | 516-626-0347
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 185411
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License Number State | NY
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