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General NPI Number Information
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NPI Number | 1750388039
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Entity Type | Individual
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Provider Name | KENNETH C LIAO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 380 2ND AVE SUITE 1000, 10TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10010-5615
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Country | US
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Telephone | 973-219-8658
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 515
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City | ROSELAND
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State | NJ
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Zip | 07068-0515
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Country | US
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Telephone |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA06723000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25MA06723000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 260274
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 260274
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License Number State | NY
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