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General NPI Number Information
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NPI Number | 1194728196
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Entity Type | Individual
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Provider Name | GAIL ELLEN SCHUPAK DMD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 30 CENTRAL PARK S SUITE 6C
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City | NEW YORK
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State | NY
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Zip | 10019-1628
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Country | US
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Telephone | 212-753-5540
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Fax | 212-980-8466
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Provider Business Mailing Address
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Address Line | 30 CENTRAL PARK SOUTH SUITE 6C
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City | NEW YORK
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State | NY
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Zip | 10019-1628
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Country | US
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Telephone | 212-753-5540
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Fax | 212-980-8466
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 037952
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License Number State | NY
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