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General NPI Number Information
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NPI Number | 1265161392
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Entity Type | Organization
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Legal Business Name | DAVIS MEDICAL PLLC
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 161 LENOX AVE
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City | NEW YORK
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State | NY
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Zip | 10026-1320
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Country | US
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Telephone | 973-868-0615
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Fax | 845-421-8668
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Provider Business Mailing Address
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Address Line | 350 HARDING DR
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1339
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Country | US
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Telephone | 973-868-0615
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Fax | 845-421-8668
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SAMPSON M DAVIS
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Credential | MD
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Telephone | 973-868-0615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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