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General NPI Number Information
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NPI Number | 1073002473
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL WELLNESS PC
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 1041 ROUTE 112
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-6000
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Country | US
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Telephone | 516-314-5377
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 463
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City | FARMINGVILLE
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State | NY
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Zip | 11738-0463
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MR. CHRISTOPHER DEFILIPPIS
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Credential |
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Telephone | 516-314-5377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 276810-1
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License Number State | NY
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