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General NPI Number Information
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NPI Number | 1467897058
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Entity Type | Individual
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Provider Name | KOMAL AMIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 25 FAIRFIELD WAY APT 1
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City | COMMACK
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State | NY
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Zip | 11725-3414
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Country | US
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Telephone | 631-462-0473
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Fax |
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Provider Business Mailing Address
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Address Line | 25 FAIRFIELD WAY APT 1
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City | COMMACK
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State | NY
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Zip | 11725-3414
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Country | US
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Telephone |
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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 | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 231868
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 231868
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License Number State | NY
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