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General NPI Number Information
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NPI Number | 1376091082
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Entity Type | Individual
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Provider Name | ALEXANDRIA SCHULTZ PAC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 09/12/2016
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Provider Practice Location Address
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Address Line | 2600 S PARK AVE
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City | LACKAWANNA
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State | NY
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Zip | 14218-1504
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Country | US
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Telephone | 716-822-2028
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Fax | 716-822-2029
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Provider Business Mailing Address
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Address Line | 4979 HARLEM RD
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City | AMHERST
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State | NY
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Zip | 14226-2547
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Country | US
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Telephone | 716-923-4381
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Fax | 716-923-4384
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 020078
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License Number State | NY
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