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General NPI Number Information
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NPI Number | 1639416746
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Entity Type | Organization
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Legal Business Name | EASTCOAST METROPOLITAN MEDICAL PC
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 1928 BAY AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-6214
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Country | US
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Telephone | 718-975-2910
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Fax | 347-462-2227
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Provider Business Mailing Address
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Address Line | 1928 BAY AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-6214
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Country | US
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Telephone | 718-975-2910
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Fax | 347-462-2227
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Authorized Official
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Title or Position | OWNER
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Name | PAULINE RAITSES
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Credential | DO
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Telephone | 718-975-2910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 264999
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License Number State | NY
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