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General NPI Number Information
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NPI Number | 1750766762
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Entity Type | Organization
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Legal Business Name | WESTSIDE NEW YORK MEDICAL, PC
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 105 STEVENS AVE SUITE 209
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City | MOUNT VERNON
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State | NY
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Zip | 10550-2686
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Country | US
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Telephone | 914-699-7700
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Fax | 914-699-7701
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Provider Business Mailing Address
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Address Line | 40 WOODLAND RD
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-1322
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Country | US
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Telephone | 914-699-7700
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Fax | 914-699-7701
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Authorized Official
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Title or Position | OWNER / MD
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Name | NONYELU IRUOMA ANYICHIE
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Credential | MD
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Telephone | 914-699-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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