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General NPI Number Information
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NPI Number | 1518098235
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Entity Type | Organization
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Legal Business Name | ASTRACLINICALLABORATORYINC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 5816 JUNCTION BLVD F3
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City | REGO PARK
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State | NY
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Zip | 11373-5155
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Country | US
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Telephone | 718-592-8948
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Fax | 718-592-8949
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Provider Business Mailing Address
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Address Line | 5816 JUNCTION BLVD F3
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City | REGO PARK
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State | NY
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Zip | 11373-5155
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Country | US
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Telephone | 718-592-8948
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Fax | 718-592-8949
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS ELEANOR REYES BARISO
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Credential | MTASCP
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Telephone | 718-592-8948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 33D0713273
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License Number State | NY
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