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General NPI Number Information
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NPI Number | 1275736670
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Entity Type | Organization
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Legal Business Name | BIMC FACULTY PRACTICE
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 10 UNION SQ E SUITE 4 K
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City | NEW YORK
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State | NY
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Zip | 10003-3314
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Country | US
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Telephone | 212-844-8930
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Fax |
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Provider Business Mailing Address
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Address Line | 150 E 42ND ST 5TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10017-5612
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Country | US
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Telephone | 646-605-4155
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT MANAGER
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Name | LUCIA GONZALEZ
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Credential |
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Telephone | 646-605-4155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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