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General NPI Number Information
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NPI Number | 1174101844
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Entity Type | Individual
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Provider Name | JASON MICHAEL CIUBOTARU MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 169 RIVERSIDE DR
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City | BINGHAMTON
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State | NY
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Zip | 13905-4198
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Country | US
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Telephone | 607-798-5280
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 ST-LOUIS
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City | MONTREAL
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State | QUEBEC
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Zip | H4M1P8
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Country | CA
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | 331837
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License Number State | NY
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