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General NPI Number Information
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NPI Number | 1174896062
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Entity Type | Organization
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Legal Business Name | GAIL MATHESON
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 259-26 145TH AVE
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City | ROSEDALE
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State | NY
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Zip | 11422
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Country | US
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Telephone | 917-459-0596
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Fax |
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Provider Business Mailing Address
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Address Line | 25926 145TH AVE
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City | ROSEDALE
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State | NY
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Zip | 11422-3302
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Country | US
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Telephone | 917-459-0596
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | GAIL MATHESON
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Credential |
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Telephone | 917-459-0596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 215034
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 215034
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License Number State | NY
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