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General NPI Number Information
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NPI Number | 1396105516
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Entity Type | Organization
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Legal Business Name | CENTER FOR PAIN AND REGENERATIVE MEDICINE, LLC
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 255 E MAIN ST
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City | RAMSEY
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State | NJ
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Zip | 07446-1902
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Country | US
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Telephone | 201-391-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 255 E MAIN ST
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City | RAMSEY
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State | NJ
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Zip | 07446-1902
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Country | US
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Telephone | 201-391-4700
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID GAMBURG
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Credential | M.D.
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Telephone | 201-391-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 0400394178
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License Number State | NJ
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