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General NPI Number Information
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NPI Number | 1902535073
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Entity Type | Individual
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Provider Name | CHINNACHART POOLA-OR
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Gender | Male
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 276 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10001-4509
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Country | US
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Telephone | 212-920-1976
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Fax |
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Provider Business Mailing Address
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Address Line | 2141 32ND ST # 2R
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City | ASTORIA
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State | NY
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Zip | 11105-2344
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Country | US
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Telephone | 917-647-8012
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P115493
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License Number State | NY
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