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General NPI Number Information
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NPI Number | 1396790028
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Entity Type | Individual
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Provider Name | BENJAMIN SPOONER PA
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 1978 CROMPOND RD
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City | CORTLANDT MNR
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State | NY
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Zip | 10567-4111
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Country | US
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Telephone | 914-736-0703
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Fax |
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Provider Business Mailing Address
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Address Line | 2649 STRANG BLVD SUITE 304
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598-2939
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Country | US
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Telephone | 914-739-0087
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Fax | 914-737-1714
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 011053
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License Number State | NY
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