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General NPI Number Information
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NPI Number | 1609534783
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Entity Type | Organization
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Legal Business Name | SHORE REGENERATIVE MEDICINE LLC
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Dates
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Enumeration Date | 12/06/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 137 ATLANTIC CITY BLVD
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City | BEACHWOOD
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State | NJ
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Zip | 08722-2935
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Country | US
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Telephone | 732-244-0222
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Fax | 732-244-0450
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Provider Business Mailing Address
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Address Line | 137 ATLANTIC CITY BLVD
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City | BEACHWOOD
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State | NJ
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Zip | 08722-2935
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Country | US
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Telephone | 732-244-0222
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Fax | 732-244-0450
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CARRIE LAVIN
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Credential |
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Telephone | 732-244-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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