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General NPI Number Information
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NPI Number | 1578606166
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Entity Type | Individual
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Provider Name | JASON STAAL PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 281 1ST AVE E 16TH ST BETH ISRAEL MEDICAL CENTER
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City | NY
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State | NY
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Zip | 10003
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Country | US
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Telephone | 212-420-2834
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Fax | 212-844-7659
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Provider Business Mailing Address
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Address Line | BETH ISRAEL MEDICAL CENTER, 1ST AVE AT 16TH ST
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City | NY
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State | NY
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Zip | 10003
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Country | US
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Telephone | 212-420-2834
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Fax | 212-844-7659
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 0134371
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License Number State | NY
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