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General NPI Number Information
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NPI Number | 1164699138
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Entity Type | Organization
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Legal Business Name | ST JAMES MEDICAL SERVICES PC
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 487 LAKE AVE
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City | ST JAMES
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State | NY
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Zip | 11780
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Country | US
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Telephone | 631-584-6014
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Fax | 631-584-6098
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Provider Business Mailing Address
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Address Line | 487 LAKE AVE PO BOX 624
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City | ST JAMES
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State | NY
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Zip | 11780
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Country | US
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Telephone | 631-584-6014
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Fax | 631-584-6098
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Authorized Official
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Title or Position | DOCTOR
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Name | EMRICK RICHARD MILLIGAN
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Credential | MD
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Telephone | 631-584-6014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 170642
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License Number State | NY
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