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General NPI Number Information
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NPI Number | 1417012790
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Entity Type | Organization
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Legal Business Name | DRS BLAU, TIGER, SULLIVAN, SUMNER
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 566 BROADWAY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5017
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Country | US
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Telephone | 516-544-6262
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Fax | 516-541-0011
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Provider Business Mailing Address
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Address Line | 566 BROADWAY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5017
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Country | US
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Telephone | 516-544-6262
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Fax | 516-541-0011
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHELDON BLAU
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Credential |
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Telephone | 516-541-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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