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General NPI Number Information
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NPI Number | 1164761953
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Entity Type | Organization
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Legal Business Name | SAUDE MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 28 WILSON TER
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City | LIVINGSTON
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State | NJ
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Zip | 07039-2941
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Country | US
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Telephone | 973-535-5279
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Fax |
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Provider Business Mailing Address
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Address Line | 28 WILSON TER
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City | LIVINGSTON
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State | NJ
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Zip | 07039-2941
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Country | US
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Telephone | 973-535-5279
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Fax |
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Authorized Official
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Title or Position | ADULT NURSE PRACTITIONER
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Name | MR. LAURO L ROCHA
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Credential | APN
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Telephone | 973-535-5279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 26NJ00133200
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License Number State | NJ
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