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General NPI Number Information
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NPI Number | 1356830954
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Entity Type | Organization
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Legal Business Name | MID ISLAND MEDICAL PC
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 285 SILLS RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4869
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Country | US
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Telephone | 631-618-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 285 SILLS RD
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4869
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Country | US
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Telephone | 631-618-9030
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MUSARRAT IQBAL
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Credential | MD
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Telephone | 631-618-9030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 234347
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License Number State | NY
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