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General NPI Number Information
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NPI Number | 1639199193
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Entity Type | Organization
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Legal Business Name | ALEXANDER Y. NEMIROVSKY, M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 323 S HELIOTROPE AVE
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City | MONROVIA
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State | CA
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Zip | 91016-2914
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Country | US
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Telephone | 310-614-5182
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5486
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City | ORANGE
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State | CA
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Zip | 92863-5486
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Country | US
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Telephone | 818-550-0900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEXANDER NEMIROVSKY
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Credential | M.D.
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Telephone | 310-614-5182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A76455
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License Number State | CA
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