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General NPI Number Information
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NPI Number | 1972841880
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Entity Type | Individual
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Provider Name | ELAYNE K. MUSTALISH M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 170 E 83RD ST APT. 4J
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City | NEW YORK
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State | NY
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Zip | 10028-1920
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Country | US
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Telephone | 212-861-1715
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Fax | 212-861-0293
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Provider Business Mailing Address
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Address Line | 170 E 83RD ST APT. 4J
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City | NEW YORK
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State | NY
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Zip | 10028-1920
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Country | US
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Telephone | 212-861-1715
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Fax | 212-861-0293
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 099581
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License Number State | NY
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