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General NPI Number Information
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NPI Number | 1073793378
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Entity Type | Organization
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Legal Business Name | REHABILITATION MEDICINE AND SPORTS SERVICES, PC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 189 MONTAGUE ST SUITE 700
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City | BROOKLYN
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State | NY
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Zip | 11201-3610
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Country | US
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Telephone | 718-852-6949
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Fax | 718-852-7075
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Provider Business Mailing Address
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Address Line | 189 MONTAGUE ST SUITE 700
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City | BROOKLYN
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State | NY
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Zip | 11201-3610
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Country | US
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Telephone | 718-852-6949
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Fax | 718-852-7075
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROL VR DECOSTA
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Credential | MD
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Telephone | 718-852-6949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 183780
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License Number State | NY
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