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General NPI Number Information
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NPI Number | 1740217371
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Entity Type | Individual
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Provider Name | JYOTI SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 151STREET,89TH AVENUE
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City | JAMAICA
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State | NY
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Zip | 11432
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Country | US
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Telephone | 718-558-2585
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Fax |
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Provider Business Mailing Address
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Address Line | 350 MOTOR PKWY STE 103
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City | HAUPPAUGE
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State | NY
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Zip | 11788-5122
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Country | US
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Telephone | 631-951-4644
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Fax | 631-951-3850
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 169615
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License Number State | NY
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