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General NPI Number Information
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NPI Number | 1588783237
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Entity Type | Individual
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Provider Name | LAWRENCE THOMAS DEMILIO M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1122 ROUTE 22 WEST, 2ND FLOOR
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092
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Country | US
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Telephone | 908-654-7399
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Fax | 908-654-7422
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Provider Business Mailing Address
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Address Line | 118 WOODBINE CIRCLE
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City | NEW PROVIDENCE
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State | NJ
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Zip | 07974-1757
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Country | US
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Telephone | 717-330-1810
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | MD036633E
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License Number State | PA
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