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General NPI Number Information
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NPI Number | 1518026772
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Entity Type | Organization
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Legal Business Name | RESTORE USA, INC.
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 10/19/2019
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Provider Practice Location Address
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Address Line | 4626 NEW UTRECHT AVE
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City | BROOKLYN
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State | NY
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Zip | 11219-2553
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Country | US
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Telephone | 718-860-4637
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Fax | 718-434-1617
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Provider Business Mailing Address
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Address Line | 338A E 7TH ST APT A
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City | BROOKLYN
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State | NY
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Zip | 11218-4106
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Country | US
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Telephone | 917-685-8171
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Fax | 718-434-1617
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Authorized Official
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Title or Position | OWNER
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Name | KEITH FREER
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Credential |
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Telephone | 718-860-4637
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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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