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General NPI Number Information
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NPI Number | 1760967723
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Entity Type | Organization
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Legal Business Name | WILLIAM J LACKEY MD PC
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 153 W 27TH ST STE 1101
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City | NEW YORK
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State | NY
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Zip | 10001-6251
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Country | US
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Telephone | 917-275-2241
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Fax |
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Provider Business Mailing Address
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Address Line | 153 W 27TH ST STE 11011000
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City | NEW YORK
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State | NY
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Zip | 10001-6203
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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 | BILLING MANAGER
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Name | MRS. ELIZABETH GOFAYZEN
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Credential |
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Telephone | 845-450-0214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number |
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License Number State |
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