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General NPI Number Information
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NPI Number | 1083513360
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Entity Type | Organization
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Legal Business Name | NOLLA MEDICAL GROUP OF NEW JERSEY PC
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Dates
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Enumeration Date | 11/03/2026
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Last Update Date | 11/03/2026
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Provider Practice Location Address
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Address Line | 45 E 20TH ST FL 9
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City | NEW YORK
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State | NY
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Zip | 10003-1347
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Country | US
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Telephone | 713-582-3663
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Fax |
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Provider Business Mailing Address
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Address Line | 45 E 20TH ST FL 9
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City | NEW YORK
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State | NY
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Zip | 10003-1347
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Country | US
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Telephone | 713-582-3663
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DON DAO
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Credential |
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Telephone | 713-582-3663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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