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General NPI Number Information
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NPI Number | 1326073214
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Entity Type | Individual
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Provider Name | KEITH RAYMOND BISCHOFF PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 1 RIVERVIEW PLZ RIVERVIEW MEDICAL CENTER
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City | RED BANK
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State | NJ
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Zip | 07701-1864
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Country | US
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Telephone | 732-530-2238
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Fax | 732-530-3808
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Provider Business Mailing Address
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Address Line | 2900 CORPORATE WAY DOOR D
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City | MIRAMAR
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State | FL
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Zip | 33025-3925
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Country | US
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Telephone | 954-276-5685
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Fax | 954-985-7074
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 25MP00146500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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