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General NPI Number Information
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NPI Number | 1063670578
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Entity Type | Organization
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Legal Business Name | IMMEDI-CARE PA
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 360 AVENUE P FL 3
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City | NEWARK
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State | NJ
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Zip | 07105
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Country | US
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Telephone | 973-643-8383
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Fax | 973-491-6099
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Provider Business Mailing Address
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Address Line | PO BOX 1296
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City | CLIFTON
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State | NJ
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Zip | 07012-0796
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Country | US
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Telephone | 973-643-8383
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Fax | 973-491-6099
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | MS. DIMITRA DENISE PALLIS
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Credential |
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Telephone | 201-874-9084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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