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General NPI Number Information
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NPI Number | 1780616383
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Entity Type | Individual
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Provider Name | CAROL LIISA KUUSISTO D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 87 5TH AVE # 89 SUITE 604
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City | NEW YORK
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State | NY
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Zip | 10003-3020
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Country | US
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Telephone | 212-675-9343
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Fax | 212-627-3770
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Provider Business Mailing Address
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Address Line | 41 5TH AVE APT. 2A
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City | NEW YORK
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State | NY
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Zip | 10003-4319
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Country | US
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Telephone | 212-533-6986
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Fax | 212-627-3770
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 232095
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License Number State | NY
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