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General NPI Number Information
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NPI Number | 1609260686
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Entity Type | Individual
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Provider Name | VIDA LEE
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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 | 10/23/2018
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Provider Practice Location Address
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Address Line | 135 MONTAGUE ST
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City | BROOKLYN
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State | NY
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Zip | 11201-3504
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Country | US
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Telephone | 646-346-7918
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Fax |
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Provider Business Mailing Address
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Address Line | 111 HICKS ST APT 7G
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City | BROOKLYN
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State | NY
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Zip | 11201-1639
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 292382
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License Number State | NY
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