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General NPI Number Information
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NPI Number | 1023903077
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Entity Type | Organization
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Legal Business Name | SPARK DEMENTIA CARE OF NEW JERSEY PC
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 224 W 35TH ST STE 500 #2031
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City | NEW YORK
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State | NY
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Zip | 10001
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Country | US
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Telephone | 332-273-0300
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Fax | 833-438-0301
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Provider Business Mailing Address
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Address Line | 224 W 35TH ST STE 500 #2031
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City | NEW YORK
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State | NY
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Zip | 10001
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Country | US
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Telephone | 332-273-0300
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MICHAEL JUSTIN COFFEY
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Credential | MD
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Telephone | 734-545-0922
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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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