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General NPI Number Information
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NPI Number | 1376807198
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Entity Type | Individual
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Provider Name | CHERYL M MARCUS-PODHAIZER DDS
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Gender | Female
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 21 S KINDERKAMACK RD
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City | MONTVALE
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State | NJ
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Zip | 07645-2112
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Country | US
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Telephone | 201-391-5565
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Fax | 201-391-8747
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Provider Business Mailing Address
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Address Line | 305 DAIBES CT
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City | EDGEWATER
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State | NJ
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Zip | 07020-1029
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Country | US
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Telephone | 201-224-2320
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI01272100
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License Number State | NJ
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