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General NPI Number Information
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NPI Number | 1942599972
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Entity Type | Organization
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Legal Business Name | NY MOHS LASER DERMATOLOGY
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 12/20/2012
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Provider Practice Location Address
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Address Line | 345 E 37TH ST #209
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City | NEW YORK
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State | NY
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Zip | 10016-3256
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Country | US
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Telephone | 646-490-7387
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Fax | 212-686-5842
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Provider Business Mailing Address
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Address Line | 345 E 37TH ST #209
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City | NEW YORK
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State | NY
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Zip | 10016-3256
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Country | US
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Telephone | 646-490-7387
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Fax | 212-686-5842
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. VICKI JOY LEVINE
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Credential | MD
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Telephone | 646-490-7387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 147719-1
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License Number State | NY
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