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General NPI Number Information
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NPI Number | 1447235833
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Entity Type | Organization
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Legal Business Name | MED-PSYCH SERVICE
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | ONE GATE WAY PLAZA 3RD FLOOR
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City | PORT CHESTER
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State | NY
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Zip | 10573
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Country | US
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Telephone | 914-202-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 43 HIGH POINT CIR
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City | RYE BROOK
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State | NY
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Zip | 10573-1092
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Country | US
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Telephone | 914-202-4949
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMAD E. NAMIN
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Credential | M.D.
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Telephone | 914-202-4949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 209565
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License Number State | NY
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