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General NPI Number Information
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NPI Number | 1245316728
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Entity Type | Organization
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Legal Business Name | DR LEON MULLEN
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 30 MERRICK AVENUE SUITE 105
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City | EAST MEADOW
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State | NY
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Zip | 11554-1580
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Country | US
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Telephone | 516-542-0255
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Fax | 516-542-0276
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Provider Business Mailing Address
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Address Line | 30 MERRICK AVENUE SUITE 105
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City | EAST MEADOW
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State | NY
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Zip | 11554-1580
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Country | US
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Telephone | 516-542-0255
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Fax | 516-542-0276
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEON MULLEN
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Credential | MD
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Telephone | 516-542-0255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 132791
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License Number State | NY
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