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General NPI Number Information
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NPI Number | 1427290907
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Entity Type | Organization
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Legal Business Name | ISLANDWIDE GASTROENTEROLOGY PC
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 03/24/2011
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Provider Practice Location Address
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Address Line | 901 STEWART AVE SUITE 240
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City | GARDEN CITY
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State | NY
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Zip | 11530-4893
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Country | US
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Telephone | 516-458-6258
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Fax | 631-223-2271
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Provider Business Mailing Address
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Address Line | 14 MAURICE LN
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City | HUNTINGTON
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State | NY
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Zip | 11743-1843
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Country | US
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Telephone | 516-458-6258
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Fax | 631-223-2271
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Authorized Official
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Title or Position | CEO
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Name | PHILIP RAYMOND CASSAR
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Credential | M.D.
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Telephone | 516-458-6258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 233299
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License Number State | NY
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