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General NPI Number Information
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NPI Number | 1174223515
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE CENTER OF NEW YORK LLC
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 66 COMMACK RD STE 103
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City | COMMACK
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State | NY
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Zip | 11725-3405
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Country | US
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Telephone | 833-547-7463
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Fax | 631-248-5583
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Provider Business Mailing Address
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Address Line | 100 MOTOR PKWY STE LL8
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City | HAUPPAUGE
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State | NY
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Zip | 11788-5165
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Country | US
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Telephone | 833-547-7463
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. AMIT SHARMA
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Credential | MD
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Telephone | 917-400-6184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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