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General NPI Number Information
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NPI Number | 1073943601
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Entity Type | Individual
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Provider Name | CARRIE M KOO L.AC
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Gender | Female
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 05/30/2015
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Provider Practice Location Address
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Address Line | 242 ROUTE 79 N SUITE 11
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City | MORGANVILLE
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State | NJ
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Zip | 07751-2078
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Country | US
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Telephone | 732-858-1322
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Fax |
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Provider Business Mailing Address
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Address Line | 308 FLOWER LN
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City | MORGANVILLE
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State | NJ
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Zip | 07751-4434
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Country | US
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Telephone | 732-533-3687
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00102500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 005179
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License Number State | NY
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