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General NPI Number Information
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NPI Number | 1376916635
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Entity Type | Organization
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Legal Business Name | EDITH
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 2123 41ST ST 1ST FLOOR
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City | ASTORIA
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State | NY
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Zip | 11105-1708
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Country | US
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Telephone | 718-755-5328
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Fax |
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Provider Business Mailing Address
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Address Line | 2123 41ST ST 1ST FLOOR
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City | ASTORIA
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State | NY
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Zip | 11105-1708
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Country | US
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Telephone | 718-755-5328
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | EDITH LAUFER
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Credential |
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Telephone | 212-288-0036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 692510
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License Number State | NY
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