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General NPI Number Information
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NPI Number | 1003518838
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Entity Type | Organization
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Legal Business Name | RESTORATIVE NEUROLOGY AND HEADACHE CENTER LLC
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 7730 BOYNTON BEACH BLVD STE 4
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-6155
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Country | US
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Telephone | 813-482-5515
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Fax | 813-537-8782
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Provider Business Mailing Address
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Address Line | 20350 COZUMEL CT
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City | BOCA RATON
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State | FL
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Zip | 33498-6712
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Country | US
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Telephone | 813-482-5515
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Fax | 813-537-8782
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. NINA TSAKADZE
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Credential | MD
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Telephone | 813-482-5515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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