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General NPI Number Information
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NPI Number | 1811529902
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Entity Type | Individual
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Provider Name | DIANNE RYAN
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Gender | Female
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Dates
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Enumeration Date | 02/07/2020
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 3630 HILL BLVD STE 401
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City | JEFFERSON VALLEY
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State | NY
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Zip | 10535-1506
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Country | US
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Telephone | 845-661-2742
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Fax |
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Provider Business Mailing Address
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Address Line | 69 HIGHLAND VIEW RD
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City | MAHOPAC
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State | NY
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Zip | 10541-3111
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Country | US
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Telephone | 845-661-2742
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 019598-1
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License Number State | NY
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