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General NPI Number Information
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NPI Number | 1588911275
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Entity Type | Organization
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Legal Business Name | WILSON MEDICAL CARE
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Dates
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Enumeration Date | 08/13/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 2 WILSON PL
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2602
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Country | US
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Telephone | 914-664-5380
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Fax |
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Provider Business Mailing Address
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Address Line | 2 WILSON PL
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2602
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Country | US
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Telephone | 914-664-5380
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Fax |
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Authorized Official
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Title or Position | CODER/COMPLIANCE
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Name | MRS. LATISHA COLES
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Credential | CPC
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Telephone | 917-767-9817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 132240
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License Number State | NY
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