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General NPI Number Information
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NPI Number | 1891265625
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Entity Type | Individual
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Provider Name | CONNOR TILLAPAUGH FAY DPT
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Gender | Male
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 12/05/2018
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Provider Practice Location Address
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Address Line | 370 LEXINGTON AVE STE 2300
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City | NEW YORK
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State | NY
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Zip | 10017-6503
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Country | US
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Telephone | 646-885-6605
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Fax |
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Provider Business Mailing Address
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Address Line | 4517 28TH AVE APT 2R
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City | ASTORIA
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State | NY
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Zip | 11103-1112
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Country | US
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Telephone | 315-263-6603
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 038350
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License Number State | NY
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