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General NPI Number Information
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NPI Number | 1205197563
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Entity Type | Organization
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Legal Business Name | SALVADOR DEOCAMPO JR
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 06/04/2012
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Provider Practice Location Address
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Address Line | 4080 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10032-1542
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Country | US
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Telephone | 212-928-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 8620 56TH AVE
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City | ELMHURST
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State | NY
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Zip | 11373-4830
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Country | US
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Telephone | 347-268-1299
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | SALVADOR DARIARTE DEOCAMPO JR.
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Credential | PT
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Telephone | 347-268-1299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 029243
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License Number State | NY
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