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General NPI Number Information
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NPI Number | 1689127334
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Entity Type | Individual
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Provider Name | ALLISON KEITZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 3644 DAY ROAD
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City | LOCKPORT
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State | NY
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Zip | 14094
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Country | US
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Telephone | 716-930-9874
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Fax |
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Provider Business Mailing Address
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Address Line | 4225 GENESEE ST STE 400
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City | CHEEKTOWAGA
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State | NY
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Zip | 14225-1994
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Country | US
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Telephone | 716-204-3200
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Fax | 716-204-4337
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 019754
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License Number State | NY
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