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General NPI Number Information
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NPI Number | 1982767067
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Entity Type | Individual
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Provider Name | MARSHALL IRA MATOS MD
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 140 LOCKWOOD AVENUE SUITE 310
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-4915
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Country | US
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Telephone | 914-576-7171
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Fax | 914-576-4770
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Provider Business Mailing Address
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Address Line | 140 LOCKWOOD AVENUE SUITE 310
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City | NEW ROCHELLE
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State | NY
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Zip | 10801-4915
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Country | US
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Telephone | 914-576-7171
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Fax | 914-840-1112
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 135068
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License Number State | NY
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