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General NPI Number Information
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NPI Number | 1093971871
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Entity Type | Organization
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Legal Business Name | NEW YORK IMMUNOLOGY LABORATORY, LLC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 4603 MIDDLE COUNTRY RD SUITE 1-23
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City | CALVERTON
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State | NY
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Zip | 11933-4104
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Country | US
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Telephone | 917-518-1983
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Fax |
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Provider Business Mailing Address
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Address Line | 4603 MIDDLE COUNTRY RD SUITE 1-23
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City | CALVERTON
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State | NY
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Zip | 11933-4104
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Country | US
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Telephone | 917-518-1983
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DJAMSHID SHIRAZIAN
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Credential | M.P.H., PH.D.
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Telephone | 917-518-1983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | SHIRD1
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License Number State | NY
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