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General NPI Number Information
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NPI Number | 1033353438
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Entity Type | Organization
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Legal Business Name | BAYONNE PEDIATRIC THERAPY CENTER LLC
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 252 BROADWAY
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City | BAYONNE
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State | NJ
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Zip | 07002-2522
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Country | US
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Telephone | 201-436-0014
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Fax | 201-436-0019
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Provider Business Mailing Address
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Address Line | 252 BROADWAY
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City | BAYONNE
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State | NJ
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Zip | 07002-2522
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Country | US
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Telephone | 201-436-0014
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Fax | 201-436-0019
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KRIS MAMMAS
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Credential | DVM
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Telephone | 201-436-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 46TR00070400
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License Number State | NJ
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