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General NPI Number Information
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NPI Number | 1982039145
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Entity Type | Organization
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Legal Business Name | OMEDNYC
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 333 E 49TH ST LOBBY E
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City | NEW YORK
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State | NY
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Zip | 10017-1680
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Country | US
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Telephone | 917-650-3883
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Fax |
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Provider Business Mailing Address
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Address Line | 26 67TH ST
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-4308
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Country | US
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Telephone | 917-650-3883
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YOKO KUO
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Credential |
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Telephone | 917-650-3883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 004069
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License Number State | NY
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