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General NPI Number Information
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NPI Number | 1790996056
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Entity Type | Organization
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Legal Business Name | LAKESIDE HEALTH SYSTEM
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1173 PECK RD
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City | HILTON
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State | NY
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Zip | 14468-9347
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Country | US
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Telephone | 585-366-4082
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Fax |
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Provider Business Mailing Address
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Address Line | 156 WEST AVE FAMILY WELLNESS CENTER
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City | BROCKPORT
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State | NY
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Zip | 14420-1229
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Country | US
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Telephone | 585-395-6044
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITIAN
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Name | MS. KAREN A. BAKER
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Credential | RD, CDE
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Telephone | 585-395-6044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 838482
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License Number State | NY
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