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General NPI Number Information
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NPI Number | 1396382685
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Entity Type | Organization
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Legal Business Name | OPTIMUM REGENERATIVE CARE LLC
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 2 STONY HILL RD STE 208
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City | BETHEL
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State | CT
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Zip | 06801-1045
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Country | US
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Telephone | 203-917-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 46 BENSON DR
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City | DANBURY
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State | CT
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Zip | 06810-7231
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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 | OWNER
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Name | STEVEN GEOFFRION
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Credential |
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Telephone | 203-917-4774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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