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General NPI Number Information
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NPI Number | 1992415459
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Entity Type | Individual
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Provider Name | JASON DIAZ PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/24/2022
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Last Update Date | 11/24/2022
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Provider Practice Location Address
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Address Line | 201 GLEN ST
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City | GLEN COVE
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State | NY
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Zip | 11542-2734
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Country | US
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Telephone | 516-671-1520
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Fax |
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Provider Business Mailing Address
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Address Line | 396 JACKSON AVE
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City | MINEOLA
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State | NY
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Zip | 11501-2238
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Country | US
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Telephone | 516-974-7576
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 069895
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License Number State | NY
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