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General NPI Number Information
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NPI Number | 1316251655
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Entity Type | Organization
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Legal Business Name | VERSACARE, INC.
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 8814 FOSTER AVE 2ND FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11236-3211
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Country | US
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Telephone | 718-531-6300
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Fax | 718-345-0012
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Provider Business Mailing Address
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Address Line | 128 ATLANTIC AVE
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City | LYNBROOK
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State | NY
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Zip | 11563-3412
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Country | US
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Telephone | 516-823-9500
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Fax | 516-823-9600
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. REDA S. SOLIMAN
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Credential | MBBCH, M.D.
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Telephone | 516-823-9500
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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 |
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License Number State |
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