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General NPI Number Information
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NPI Number | 1154396893
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Entity Type | Individual
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Provider Name | MOHAMMAD REZA MOIENAFSHARI M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 01/25/2020
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Provider Practice Location Address
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Address Line | 644 W PUTNAM AVE
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City | GREENWICH
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State | CT
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Zip | 06830-6088
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Country | US
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Telephone | 203-210-2810
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Fax | 203-210-2811
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Provider Business Mailing Address
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Address Line | 2700 WESTCHESTER AVE
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City | PURCHASE
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State | NY
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Zip | 10577-2547
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Country | US
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Telephone | 914-607-5730
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 302563
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 039581
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License Number State | CT
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