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General NPI Number Information
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NPI Number | 1457735094
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE PODIATRY, PLLC
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 20 HICKSVILLE RD SUITE 2
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5819
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Country | US
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Telephone | 516-744-0354
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Fax | 855-959-1613
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Provider Business Mailing Address
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Address Line | 20 HICKSVILLE RD SUITE 2
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City | MASSAPEQUA
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State | NY
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Zip | 11758-5819
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Country | US
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Telephone | 516-744-0354
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Fax | 855-959-1613
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. MITAL B PATEL
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Credential | DPM
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Telephone | 516-590-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N006053-1
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License Number State | NY
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