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General NPI Number Information
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NPI Number | 1770718009
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Entity Type | Organization
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Legal Business Name | ENDOSCOPY CENTER OF LONG ISLAND LLC
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Dates
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Enumeration Date | 05/15/2009
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Last Update Date | 05/15/2009
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Provider Practice Location Address
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Address Line | 711 STEWART AVE SUITE 114
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City | GARDEN CITY
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State | NY
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Zip | 11530-4731
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Country | US
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Telephone | 516-227-3254
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Fax | 516-998-4078
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Provider Business Mailing Address
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Address Line | 711 STEWART AVE SUITE 114
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City | GARDEN CITY
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State | NY
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Zip | 11530-4731
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Country | US
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Telephone | 516-227-3254
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Fax | 516-998-4078
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | WARREN MORRIS
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Credential |
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Telephone | 516-227-3254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number | 2905202R
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License Number State | NY
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