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General NPI Number Information
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NPI Number | 1518435007
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Entity Type | Organization
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Legal Business Name | PHYSICIAN HEALTH AND WELLNESS
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 2106 NEW RD STE E2
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City | LINWOOD
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State | NJ
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Zip | 08221-1052
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Country | US
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Telephone | 201-230-6637
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Fax |
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Provider Business Mailing Address
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Address Line | 700 AVENUE C STE 1
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City | BAYONNE
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State | NJ
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Zip | 07002-5837
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Country | US
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Telephone | 201-230-6637
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JO-ANN SHAKARJIAN
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Credential | MD
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Telephone | 201-471-2109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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