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General NPI Number Information
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NPI Number | 1356831309
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Entity Type | Organization
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Legal Business Name | PURE MEDICAL SERVICES PC
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 2000 N VILLAGE AVE STE 202
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570
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Country | US
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Telephone | 347-804-7277
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Fax |
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Provider Business Mailing Address
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Address Line | 79 S 3RD ST
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City | BETHPAGE
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State | NY
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Zip | 11714-2605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | IC
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Name | MISS RENU GILL
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Credential | IC
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Telephone | 718-640-3960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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