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General NPI Number Information
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NPI Number | 1184818023
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Entity Type | Organization
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Legal Business Name | SURGAIDE
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 555 KINDERKAMACK RD
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City | ORADELL
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State | NJ
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Zip | 07649-1517
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Country | US
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Telephone | 201-262-0075
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Fax | 201-262-9440
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Provider Business Mailing Address
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Address Line | P O BOX 4397
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City | CLIFTON
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State | NJ
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Zip | 07012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSH EMANUEL
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Credential |
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Telephone | 973-774-5050
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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 | 25MA02149700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA02149700
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License Number State | NJ
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