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General NPI Number Information
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NPI Number | 1508197799
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Entity Type | Organization
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Legal Business Name | EXTENDED OPTIMUM MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 1130 ROUTE 202 SUITE #6 BLDG E
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City | RARITAN
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State | NJ
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Zip | 08869-1490
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Country | US
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Telephone | 908-644-2650
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Fax |
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Provider Business Mailing Address
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Address Line | 30 WORLDS FAIR DR SUITE110
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City | SOMERSET
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State | NJ
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Zip | 08873-1346
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Country | US
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Telephone | 908-644-2650
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS TAWANA LAE GRACE
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Credential |
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Telephone | 908-644-2650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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