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General NPI Number Information
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NPI Number | 1235991969
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Entity Type | Individual
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Provider Name | DAMON FULLER
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Gender | Male
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 89 5TH AVE STE 306
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City | NEW YORK
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State | NY
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Zip | 10003-3020
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Country | US
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Telephone | 347-772-7810
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Fax |
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Provider Business Mailing Address
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Address Line | 829 LAFAYETTE AVE APT 4A
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City | BROOKLYN
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State | NY
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Zip | 11221-1979
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Country | US
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Telephone | 347-772-7810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 030137
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License Number State | NY
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