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General NPI Number Information
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NPI Number | 1366331027
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Entity Type | Individual
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Provider Name | LUC LANDRY SUMO KOUATCHO
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Gender | Male
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 355 BARD AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10310-1664
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Country | US
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Telephone | 718-818-1645
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Fax |
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Provider Business Mailing Address
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Address Line | 288 KISSEL AVE APT 2D
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City | STATEN ISLAND
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State | NY
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Zip | 10310-1636
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Country | US
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Telephone | 240-491-1319
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State | NY
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