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General NPI Number Information
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NPI Number | 1932656444
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Entity Type | Individual
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Provider Name | ANGELINA REYNOSO
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Gender | Female
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 25 STORMVILLE RD
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City | HOPEWELL JUNCTION
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State | NY
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Zip | 12533-6245
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Country | US
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Telephone | 845-505-0683
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Fax |
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Provider Business Mailing Address
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Address Line | 630 FLUSHING AVE
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City | BROOKLYN
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State | NY
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Zip | 11206-5026
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Country | US
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Telephone | 718-828-2666
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 686800
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License Number State | NY
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