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General NPI Number Information
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NPI Number | 1619038841
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Entity Type | Individual
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Provider Name | GAIL E CORREALE O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 1600 STEWART AVE SUITE 108
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City | WESTBURY
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State | NY
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Zip | 11590-6696
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Country | US
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Telephone | 516-280-3646
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Fax | 516-783-6550
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Provider Business Mailing Address
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Address Line | 88 JENKINS ST
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City | MERRICK
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State | NY
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Zip | 11566-1714
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Country | US
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Telephone | 516-223-1902
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV006373
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License Number State | NY
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