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General NPI Number Information
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NPI Number | 1144684630
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Entity Type | Organization
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Legal Business Name | ACLD
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 910 MELVILLE ESTATES CT
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City | MELVILLE
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State | NY
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Zip | 11747-2827
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Country | US
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Telephone | 631-385-4303
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Fax |
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Provider Business Mailing Address
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Address Line | 807 S OYSTER BAY RD
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City | BETHPAGE
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State | NY
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Zip | 11714-1030
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Country | US
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Telephone | 516-822-0028
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Fax | 516-822-8108
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT GOLDSMITH
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Credential |
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Telephone | 516-822-0028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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