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General NPI Number Information
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NPI Number | 1437452794
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Entity Type | Individual
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Provider Name | ROEL JOZEF KARL REINARTZ BACHALOR
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Gender | Male
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 435 GLENWOOD ROAD
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City | BINGHAMTON
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State | NY
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Zip | 13905-1606
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Country | US
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Telephone | 607-763-3425
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Fax |
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Provider Business Mailing Address
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Address Line | 23 WEST GLANN ROAD
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City | APALACHIN
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State | NY
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Zip | 13732-4026
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Country | US
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Telephone | 607-258-0310
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 018749-1
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License Number State | NY
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