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General NPI Number Information
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NPI Number | 1669982617
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Entity Type | Organization
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Legal Business Name | VICENTE J LIZ DEFILLO
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 30 W 60TH ST APT 1F
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City | NEW YORK
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State | NY
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Zip | 10023-7906
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Country | US
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Telephone | 646-359-1012
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Fax | 718-960-2023
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Provider Business Mailing Address
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Address Line | 1295 5TH AVE APT 33D
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City | NEW YORK
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State | NY
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Zip | 10029-3134
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Country | US
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Telephone | 646-359-1012
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Fax | 718-960-2023
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Authorized Official
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Title or Position | PRACTITIONER
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Name | VICENTE J LIZ DEFILLO
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Credential | M.D.
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Telephone | 646-359-1012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 270405
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License Number State | NY
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