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General NPI Number Information
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NPI Number | 1851643704
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Entity Type | Organization
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Legal Business Name | SOUTHSIDE HOSPITAL
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 301 E MAIN ST
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City | BAY SHORE
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State | NY
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Zip | 11706-8408
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Country | US
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Telephone | 631-422-6166
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Fax | 631-422-6269
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Provider Business Mailing Address
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Address Line | PO BOX 417683
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City | BOSTON
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State | MA
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Zip | 02241-7640
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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 | EXECUTIVE VP AND CFO
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Name | MR. ROBERT S SHAPIRO
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Credential |
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Telephone | 516-465-8182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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