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General NPI Number Information
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NPI Number | 1457796567
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY INSTITUTE AND LASER CENTER
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Dates
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Enumeration Date | 05/02/2013
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 1100 CLIFTON AVE
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City | CLIFTON
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State | NJ
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Zip | 07013
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Country | US
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Telephone | 973-472-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 CLIFTON AVE
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City | CLIFTON
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State | NJ
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Zip | 07013
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Country | US
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Telephone | 973-472-1000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADRIANA O ROS
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Credential | DO
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Telephone | 973-472-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 25MB08665600
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License Number State | NJ
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