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General NPI Number Information
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NPI Number | 1699960617
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Entity Type | Individual
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Provider Name | LAWRENCE W SHIELDS M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 736 E PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-2605
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Country | US
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Telephone | 516-889-1424
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Fax | 516-432-3151
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Provider Business Mailing Address
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Address Line | 736 E PARK AVE
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City | LONG BEACH
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State | NY
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Zip | 11561-2605
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Country | US
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Telephone | 516-889-1424
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Fax | 516-432-3151
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 1005669
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License Number State | NY
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