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General NPI Number Information
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NPI Number | 1154898187
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Entity Type | Organization
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Legal Business Name | MEDPRO MOVIL LLC
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 16808 HILLSIDE AVE
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City | JAMAICA
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State | NY
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Zip | 11432-4341
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Country | US
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Telephone | 718-739-1400
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Fax | 800-732-1219
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Provider Business Mailing Address
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Address Line | 1024 PENINSULA BLVD
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City | WOODMERE
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State | NY
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Zip | 11598-1542
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Country | US
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Telephone | 718-739-1400
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Fax | 800-732-1219
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Authorized Official
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Title or Position | DIRECTOR
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Name | MOHAMMAD SADIQUE
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Credential |
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Telephone | 718-739-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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