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General NPI Number Information
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NPI Number | 1114245875
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Entity Type | Organization
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Legal Business Name | GRAMERCY OBS FACILITY LLC
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 216 E 23RD ST
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City | NEW YORK
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State | NY
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Zip | 10010-4605
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Country | US
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Telephone | 212-889-1380
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Fax | 212-686-2830
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Provider Business Mailing Address
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Address Line | 216 E 23RD ST
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City | NEW YORK
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State | NY
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Zip | 10010-4605
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Country | US
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Telephone | 212-889-1380
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Fax | 212-686-2830
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARC S MOSER
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Credential | DPM
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Telephone | 212-889-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | N003197-1
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License Number State | NY
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