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General NPI Number Information
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NPI Number | 1851565741
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Entity Type | Organization
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Legal Business Name | JAMES E. CARLSON D.O., P.C.
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 815 HALLOCK AVE SUITE B
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1220
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Country | US
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Telephone | 631-928-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 815 HALLOCK AVE SUITE B
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1220
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JAMES E CARLSON
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Credential | D.O.
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Telephone | 631-928-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 204062
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License Number State | NY
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