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General NPI Number Information
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NPI Number | 1174811962
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Entity Type | Individual
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Provider Name | SYDNEY E ROSE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 2800 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-4292
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Country | US
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Telephone | 203-545-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 99 EAST RIVER DRIVE 5TH FLOOR
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City | EAST HARTFORD
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State | CT
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Zip | 06108
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Country | US
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 172652
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License Number State | OR
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