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General NPI Number Information
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NPI Number | 1396926168
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Entity Type | Individual
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Provider Name | LEO S GRAY
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Gender | Male
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 594 ATLANTIC AVE
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1539
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Country | US
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Telephone | 516-599-2627
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Fax |
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Provider Business Mailing Address
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Address Line | 3910 BAYBERRY LN
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City | SEAFORD
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State | NY
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Zip | 11783-1506
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 049890
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License Number State | NY
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