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General NPI Number Information
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NPI Number | 1922107085
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Entity Type | Individual
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Provider Name | DEREK JRW WILLIAMS PA
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 320 E 94TH ST FL 2 MOUNT SINAI ADOLESCENT HEALTH CENTER
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City | NEW YORK
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State | NY
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Zip | 10128-5604
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Country | US
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Telephone | 212-731-7530
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Fax | 212-423-2920
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Provider Business Mailing Address
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Address Line | 4260 BROADWAY SUITE 601
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City | NEW YORK
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State | NY
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Zip | 10033-3726
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Country | US
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Telephone | 347-789-7556
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Fax | 419-858-4738
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 005384-1
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License Number State | NY
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