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General NPI Number Information
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NPI Number | 1144457151
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Entity Type | Organization
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Legal Business Name | ONE MEDICAL GROUP, PC
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 489 5TH AVE 3RD FLOOR
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City | NEW YORK
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State | NY
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Zip | 10017-6109
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Country | US
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Telephone | 212-530-2269
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26170
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City | SAN FRANCISCO
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State | CA
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Zip | 94126-6170
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Country | US
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Telephone | 212-530-2269
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | DEBRA BENAVIDEZ
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Credential |
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Telephone | 212-530-2269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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