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General NPI Number Information
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NPI Number | 1316263924
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Entity Type | Organization
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Legal Business Name | CENTROMERE DIAGNOSTIC, LLC
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 230 W PASSAIC ST
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City | MAYWOOD
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State | NJ
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Zip | 07607-1267
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Country | US
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Telephone | 201-289-8766
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Fax | 201-289-8764
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Provider Business Mailing Address
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Address Line | 230 W PASSAIC ST
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City | MAYWOOD
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State | NJ
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Zip | 07607-1267
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Country | US
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Telephone | 201-289-8766
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Fax | 201-289-8764
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HOSAM EL-SHERBINY
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Credential | M.D.
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Telephone | 201-289-8765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 00017464
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License Number State | NJ
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