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General NPI Number Information
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NPI Number | 1457562522
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Entity Type | Individual
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Provider Name | ANNE MARIE ONDRICEK MD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 CENTER DR FIRST FLOOR, SOUTH WING
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City | RIVERHEAD
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State | NY
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Zip | 11901-3393
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Country | US
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Telephone | 631-852-1821
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Fax | 631-852-3723
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Provider Business Mailing Address
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Address Line | 645 BELLE TERRE RD APT 10
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1900
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Country | US
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Telephone | 631-828-6574
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 241701
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License Number State | NY
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