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General NPI Number Information
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NPI Number | 1730873597
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Entity Type | Individual
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Provider Name | RAJ VAIDYA OD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 16413 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11432-4913
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Country | US
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Telephone | 929-218-7155
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Fax | 929-218-7157
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Provider Business Mailing Address
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Address Line | 3525 170TH ST
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City | FLUSHING
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State | NY
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Zip | 11358-1823
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Country | US
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Telephone | 929-260-9982
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 009839
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License Number State | NY
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