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General NPI Number Information
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NPI Number | 1669846341
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Entity Type | Individual
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Provider Name | EMILIA KATHLEEN PELUSO PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 7375 OSWEGO RD STE 2
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City | LIVERPOOL
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State | NY
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Zip | 13090-3717
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Country | US
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Telephone | 315-461-2256
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Fax | 315-461-2257
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Provider Business Mailing Address
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Address Line | PO BOX 500
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City | ELLICOTTVILLE
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State | NY
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Zip | 14731-0500
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Country | US
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Telephone | 716-669-9032
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 019233
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License Number State | NY
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