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General NPI Number Information
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NPI Number | 1073862397
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Entity Type | Organization
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Legal Business Name | SMB MEDICAL, P.C.
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 5901 94TH ST STE. E10
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City | ELMHURST
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State | NY
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Zip | 11373-5049
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Country | US
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Telephone | 718-271-3548
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Fax |
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Provider Business Mailing Address
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Address Line | 9522 63RD RD #531
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City | REGO PARK
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State | NY
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Zip | 11374-1142
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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 | OWNER
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Name | MRS. STEPHANIE MIRIAM BAYNER
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Credential | M.D.
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Telephone | 718-760-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 231488
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License Number State | NY
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