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General NPI Number Information
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NPI Number | 1679240329
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Entity Type | Individual
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Provider Name | DR. SUNNY MUKUL RAITHATHA
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Gender | Male
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Dates
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Enumeration Date | 08/29/2021
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Last Update Date | 08/29/2021
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Provider Practice Location Address
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Address Line | 461 CENTRAL AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07307-2740
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Country | US
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Telephone | 201-420-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 59 MAGNOLIA AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07306-1813
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Country | US
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Telephone | 201-724-2227
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 009437
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License Number State | NY
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