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General NPI Number Information
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NPI Number | 1174515712
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Entity Type | Organization
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Legal Business Name | CENTRAL NEW YORK PET LLC
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5100 W TAFT RD SUITE 2C
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City | LIVERPOOL
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State | NY
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Zip | 13088-3807
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Country | US
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Telephone | 315-452-2666
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Fax | 315-452-2669
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Provider Business Mailing Address
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Address Line | 4567 CROSSROADS PARK DR 2ND FLOOR
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City | LIVERPOOL
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State | NY
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Zip | 13088-3589
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Country | US
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Telephone | 315-295-2100
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Fax | 315-295-2125
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | DR. ALAN B FOSTER
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Credential | M.D.
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Telephone | 315-452-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 108725
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License Number State | NY
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