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General NPI Number Information
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NPI Number | 1336555077
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Entity Type | Individual
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Provider Name | KATIE GILLILAND MSED
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Gender | Female
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 460 WEST 34TH STREET 11TH FLOOR YAI LIFESTART
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City | NEW YORK
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State | NY
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Zip | 10001
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Country | US
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Telephone | 646-291-8386
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Fax |
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Provider Business Mailing Address
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Address Line | 3343 CRESCENT ST APT 6A
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City | ASTORIA
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State | NY
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Zip | 11106-3835
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Country | US
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Telephone | 718-986-6895
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1276273
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License Number State | NY
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