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General NPI Number Information
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NPI Number | 1083021703
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Entity Type | Organization
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Legal Business Name | RICHARD A.MINGIONEMD
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 4127 ATLANTIC AVE
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-5829
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Country | US
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Telephone | 609-347-7135
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Fax | 609-347-6336
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Provider Business Mailing Address
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Address Line | 4127 ATLANTIC AVE
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-5829
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Country | US
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Telephone | 609-347-7135
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Fax | 609-347-6336
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. TASHIANA WALKER
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Credential | MA
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Telephone | 609-347-7135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MA37937
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License Number State | NJ
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