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General NPI Number Information
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NPI Number | 1144750670
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Entity Type | Individual
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Provider Name | LEAH DEREGE SEIFU MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 3959 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10032-1559
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Country | US
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Telephone | 212-305-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 574 W END AVE APT 63
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City | NEW YORK
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State | NY
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Zip | 10024-2726
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Country | US
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Telephone | 215-590-1220
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT213948
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 323664
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License Number State | NY
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