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General NPI Number Information
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NPI Number | 1336229350
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Entity Type | Individual
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Provider Name | PHYLLIS WEINGARTEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 4 MEDICAL PARK DR
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City | POMONA
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State | NY
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Zip | 10970-3516
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Country | US
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Telephone | 845-354-6225
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Fax | 845-354-6335
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Provider Business Mailing Address
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Address Line | 8 BAKER LN
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City | SUFFERN
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State | NY
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Zip | 10901-2402
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Country | US
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Telephone | 845-362-8523
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 173064 1
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License Number State | NY
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