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General NPI Number Information
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NPI Number | 1366996423
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Entity Type | Organization
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Legal Business Name | MANHATTAN MYOFUNCTIONAL THERAPY, LLC
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Dates
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Enumeration Date | 08/06/2016
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Last Update Date | 11/19/2016
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Provider Practice Location Address
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Address Line | 265 MADISON AVE FL 2
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City | NEW YORK
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State | NY
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Zip | 10016-0971
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Country | US
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Telephone | 646-926-1696
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Fax |
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Provider Business Mailing Address
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Address Line | 265 MADISON AVE FL 2
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City | NEW YORK
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State | NY
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Zip | 10016-0971
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Country | US
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Telephone | 646-926-1696
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Fax |
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Authorized Official
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Title or Position | OROFACIAL MYOFUNCTIONAL THERAPIST
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Name | MARTHA MACALUSO
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Credential | MLT, RDH, MS.ED
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Telephone | 646-926-1696
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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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