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General NPI Number Information
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NPI Number | 1528106010
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Entity Type | Individual
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Provider Name | MARCIA BRUCCULERI
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 SOUTH AVE
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City | GARDEN CITY
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State | NY
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Zip | 11530-4213
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Country | US
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Telephone | 516-877-4845
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Fax |
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Provider Business Mailing Address
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Address Line | 7 TORREY PINE LN
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City | BAY SHORE
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State | NY
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Zip | 11706-5864
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Country | US
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Telephone | 631-277-3257
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 001817
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License Number State | NY
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