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General NPI Number Information
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NPI Number | 1942389010
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Entity Type | Organization
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Legal Business Name | RICHARD DRANITZKE, MD
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 635 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1935
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Country | US
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Telephone | 631-473-1602
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Fax |
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Provider Business Mailing Address
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Address Line | 635 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1935
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Country | US
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Telephone | 631-473-1602
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Fax |
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Authorized Official
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Title or Position | MD
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Name | RICHARD DRANITZKE
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Credential | MD
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Telephone | 631-473-1602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 099574
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License Number State | NY
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