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General NPI Number Information
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NPI Number | 1700993375
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Entity Type | Individual
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Provider Name | LALAINE T QUE MD
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 550 MONTAUK HWY
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City | SHIRLEY
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State | NY
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Zip | 11967
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Country | US
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Telephone | 631-852-1001
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Fax | 631-852-1122
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Provider Business Mailing Address
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Address Line | 29 RIVERVIEW TERRACE
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-360-8131
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 211356
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License Number State | NY
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