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General NPI Number Information
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NPI Number | 1013914175
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Entity Type | Individual
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Provider Name | RONALD SIWOFF O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 75 BLOOMFIELD AVE SUITE 206
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City | DENVILLE
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State | NJ
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Zip | 07834-2734
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Country | US
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Telephone | 973-627-7787
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Fax | 973-627-7701
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Provider Business Mailing Address
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Address Line | 75 BLOOMFIELD AVE SUITE 206
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City | DENVILLE
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State | NJ
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Zip | 07834-2734
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Country | US
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Telephone | 973-627-7787
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Fax | 973-627-7701
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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 | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 27OA003818
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License Number State | NJ
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