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General NPI Number Information
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NPI Number | 1699018200
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Entity Type | Organization
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Legal Business Name | OCEANSIDE SURGERY, LLC
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Dates
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Enumeration Date | 04/02/2013
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Last Update Date | 04/02/2013
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Provider Practice Location Address
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Address Line | 2240 W WOOLBRIGHT RD SUITE 405
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6332
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Country | US
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Telephone | 561-832-9440
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Fax | 561-832-9396
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Provider Business Mailing Address
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Address Line | 2240 W WOOLBRIGHT RD SUITE 405
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-6332
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Country | US
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Telephone | 561-832-9440
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Fax | 561-832-9396
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Authorized Official
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Title or Position | OWNER
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Name | JOHN THOMAS MALCYNSKI
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Credential | MD, FACS, FCCP
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Telephone | 561-832-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | ME112973
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License Number State | FL
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