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General NPI Number Information
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NPI Number | 1124464532
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Entity Type | Organization
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Legal Business Name | SUNRISE MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 543 E 137TH ST
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City | BRONX
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State | NY
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Zip | 10454-4225
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Country | US
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Telephone | 917-891-8500
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Fax | 917-891-8501
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Provider Business Mailing Address
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Address Line | 219 20TH ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-3913
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Country | US
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Telephone | 917-891-8500
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Fax | 917-891-8501
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Authorized Official
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Title or Position | PRESIDENT / CFO
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Name | DR. SURESH VEERAMACHANENI
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Credential | M.D.
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Telephone | 917-891-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 243118-1
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License Number State | NY
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