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General NPI Number Information
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NPI Number | 1184252108
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Entity Type | Individual
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Provider Name | ROMANA IMTIAZ SYED
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Gender | Female
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | LIZA M DOMINIONI,MATHER HOSPITAL,INTERNAL MEDICINE RESIDENCY PROGRAM,LEVEL 2-CMO SUITE,75 N COUNTRY RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-686-2517
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Fax | 631-686-7651
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Provider Business Mailing Address
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Address Line | LIZA M DOMINIONI,MATHER HOSPITAL,INTERNAL MEDICINE RESIDENCY PROGRAM,LEVEL 2-CMO SUITE,75 N COUNTRY RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-686-2517
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Fax | 631-686-7651
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 324110
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License Number State | NY
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