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General NPI Number Information
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NPI Number | 1558017038
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Entity Type | Organization
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Legal Business Name | MICHAEL R JURKOWICH
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 783 POST RD # 785
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City | SCARSDALE
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State | NY
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Zip | 10583-5010
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Country | US
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Telephone | 718-554-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 7 FAIRVIEW AVE
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City | PORT WASHINGTON
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State | NY
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Zip | 11050-4013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | DEBRA L SCOTT
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Credential |
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Telephone | 407-797-5958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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