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General NPI Number Information
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NPI Number | 1952696288
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Entity Type | Organization
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Legal Business Name | LIVINGSTON MEDICAL ASSOCIATES, PC
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 825 SEVENTH AVE SUITE LL
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City | NEW YORK
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State | NY
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Zip | 10019
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Country | US
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Telephone | 646-270-7357
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Fax |
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Provider Business Mailing Address
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Address Line | 200 WINSTON DR APT. 805
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City | CLIFFSIDE PK
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State | NJ
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Zip | 07010-3235
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Country | US
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Telephone | 646-270-7357
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VADIM SURIKOV
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Credential | DO
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Telephone | 646-270-7357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 208907
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License Number State | NY
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