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General NPI Number Information
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NPI Number | 1417038373
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Entity Type | Individual
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Provider Name | MICHAEL VICTOR VENANZI MD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 390 ROUTE 10 SUITE 1
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City | RANDOLPH
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State | NJ
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Zip | 07869-2141
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Country | US
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Telephone | 973-328-1262
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Fax | 973-328-8576
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Provider Business Mailing Address
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Address Line | 539 OPENAKI RD
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City | RANDOLPH
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State | NJ
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Zip | 07869-3318
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Country | US
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Telephone | 973-361-1149
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA03937700
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License Number State | NJ
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