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General NPI Number Information
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NPI Number | 1528715158
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Entity Type | Organization
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Legal Business Name | GLEN COVE RADIOLOGIC IMAGING LLC
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Dates
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Enumeration Date | 03/03/2022
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 1825 RIVERSIDE DR APT 1B
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City | NEW YORK
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State | NY
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Zip | 10034-5308
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Country | US
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Telephone | 631-269-0888
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1391
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City | COMMACK
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State | NY
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Zip | 11725-0930
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Country | US
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Telephone | 631-269-0888
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Fax | 631-326-0286
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Authorized Official
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Title or Position | MD, OWNER
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Name | DR. PAUL BONHEIM
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Credential | MD
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Telephone | 631-269-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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