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General NPI Number Information
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NPI Number | 1659177509
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Entity Type | Organization
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Legal Business Name | JOHN T MATHER MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 75 N COUNTRY RD FL 2
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2119
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Country | US
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Telephone | 516-256-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 75 N COUNTRY RD FL 2
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2119
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Country | US
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Telephone | 516-256-6688
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Fax |
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Authorized Official
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Title or Position | EVP & CFO
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Name | MICHELE L CUSACK
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Credential |
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Telephone | 516-321-6058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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