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General NPI Number Information
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NPI Number | 1437271681
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Entity Type | Organization
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Legal Business Name | SUMMER RIVER INC COMPLETE MEDICAL
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 90-09 ROCKAWAY BEACH BLVD
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693-1531
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Country | US
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Telephone | 718-945-9119
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Fax | 718-945-6034
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Provider Business Mailing Address
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Address Line | 20419 12TH AVE
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City | ROCKAWAY POINT
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State | NY
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Zip | 11697-1120
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Country | US
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Telephone | 718-945-9119
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Fax | 718-945-6034
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Authorized Official
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Title or Position | OWNER
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Name | ED FLANAGAN
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Credential |
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Telephone | 917-363-3460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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