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General NPI Number Information
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NPI Number | 1902885601
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Entity Type | Individual
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Provider Name | JEFFREY J VISCO M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 4955 N BAILEY AVE SUITE 205
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City | AMHERST
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State | NY
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Zip | 14226
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Country | US
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Telephone | 716-857-8751
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Fax | 716-961-2225
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Provider Business Mailing Address
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Address Line | 425 ESSJAY RD STE 170
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5782
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Country | US
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Telephone | 716-630-1219
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Fax | 716-817-1726
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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 | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 229881-1
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License Number State | NY
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