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General NPI Number Information
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NPI Number | 1205811049
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Entity Type | Organization
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Legal Business Name | SOUTH OCEAN CARE LLC
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 101 S BERGEN PL
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City | FREEPORT
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State | NY
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Zip | 11520-3528
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Country | US
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Telephone | 516-623-3600
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Fax | 516-623-9191
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Provider Business Mailing Address
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Address Line | PO BOX 624
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City | WOODMERE
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State | NY
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Zip | 11598-0624
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Country | US
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Telephone | 516-623-3600
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Fax | 516-623-9191
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MARK A RAIFMAN
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Credential | MD
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Telephone | 516-623-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2904201R
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License Number State | NY
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