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General NPI Number Information
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NPI Number | 1164778130
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Entity Type | Organization
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Legal Business Name | ABUL SHAHIDULLAH, M. D., MEDICAL OFFICE
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 62 65 FOREST AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-2001
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Country | US
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Telephone | 718-366-7999
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Fax | 718-366-6468
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Provider Business Mailing Address
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Address Line | 899 WOODMERE DR
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City | VALLEY STREAM
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State | NY
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Zip | 11581-2735
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Country | US
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Telephone | 718-366-7999
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Fax | 718-366-6468
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Authorized Official
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Title or Position | OWNER
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Name | ABUL SHAHIDULLAH
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Credential | M. D.
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Telephone | 718-366-7999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 187626
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License Number State | NY
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