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General NPI Number Information
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NPI Number | 1679933998
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Entity Type | Organization
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Legal Business Name | TAREK R KHATER
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 08/08/2020
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Provider Practice Location Address
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Address Line | 2814 31ST ST SUITE 501
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City | ASTORIA
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State | NY
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Zip | 11102
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Country | US
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Telephone | 917-960-0821
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Fax | 713-575-3865
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Provider Business Mailing Address
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Address Line | PO BOX 672
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City | NEW YORK
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State | NY
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Zip | 10028-0044
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Country | US
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Telephone | 917-960-0821
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Fax | 646-952-2004
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Authorized Official
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Title or Position | OWENER
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Name | TAREK R KHATER
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Credential | MD
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Telephone | 917-960-0821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 300724
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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