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General NPI Number Information
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NPI Number | 1770845448
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Entity Type | Organization
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Legal Business Name | ADVANCED SPEECH PATHOLOGY
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 500 W MAIN ST STE 208
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City | BABYLON
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State | NY
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Zip | 11702-3032
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Country | US
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Telephone | 631-482-1200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 504
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City | MOUNT SINAI
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State | NY
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Zip | 11766-0504
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Country | US
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Telephone | 631-482-1200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN AMATO
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Credential | EDD
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Telephone | 631-482-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 00087
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 000087
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License Number State | NY
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