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General NPI Number Information
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NPI Number | 1982670089
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Entity Type | Organization
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Legal Business Name | ANTHONY J MSTELLONE MD PLLC
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 15211 89TH AVE
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City | JAMAICA
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State | NY
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Zip | 11432-3730
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Country | US
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Telephone | 718-558-2072
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Fax |
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Provider Business Mailing Address
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Address Line | 12 HILLTOP LN
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City | OYSTER BAY
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State | NY
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Zip | 11771-3912
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Country | US
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Telephone | 718-558-2072
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY J MASTELLONE
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Credential | MD
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Telephone | 718-558-2072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 119240
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License Number State | NY
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