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General NPI Number Information
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NPI Number | 1548622301
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Entity Type | Individual
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Provider Name | NICOLE MATAR MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 1 BLACHLEY RD
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City | STAMFORD
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State | CT
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Zip | 06902-0002
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Country | US
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Telephone | 203-705-0948
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Fax | 203-705-0938
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Provider Business Mailing Address
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Address Line | PO BOX 626
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City | GREAT RIVER
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State | NY
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Zip | 11739-0626
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Country | US
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Telephone | 631-892-2745
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Fax | 631-201-3179
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MA11138600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 302738
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 79958
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License Number State | CT
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