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General NPI Number Information
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NPI Number | 1528452539
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Entity Type | Individual
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Provider Name | PRIYA DIPAK KHOLWADWALA D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 210-31 26TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11360-1949
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Country | US
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Telephone | 718-747-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 3 BALSAM DR
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City | HICKSVILLE
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State | NY
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Zip | 11801-2004
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Country | US
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Telephone | 516-244-3349
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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 | 28576301
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License Number State | NY
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