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General NPI Number Information
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NPI Number | 1295132991
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Entity Type | Organization
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Legal Business Name | JUAN VAILLANT MEDICAL PLLC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 2818 STEINWAY ST
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City | ASTORIA
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State | NY
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Zip | 11103-3349
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Country | US
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Telephone | 718-892-9373
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Fax |
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Provider Business Mailing Address
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Address Line | 2818 STEINWAY ST
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City | ASTORIA
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State | NY
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Zip | 11103-3349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | JUAN VAILLANT
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Credential | M.D.
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Telephone | 718-892-9373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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