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General NPI Number Information
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NPI Number | 1790876324
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Entity Type | Organization
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Legal Business Name | KITAJ HEADACHE CENTER LLC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 2649 STRANG BLVD SUITE 208
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598-2939
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Country | US
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Telephone | 914-245-3962
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Fax | 914-254-3963
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Provider Business Mailing Address
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Address Line | 2649 STRANG BLVD SUITE 208
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City | YORKTOWN HEIGHTS
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State | NY
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Zip | 10598-2939
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Country | US
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Telephone | 914-245-3962
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Fax | 914-254-3963
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. MADELEINE B KITAJ
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Credential | M.D.
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Telephone | 203-262-8430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 205773
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License Number State | NY
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