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General NPI Number Information
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NPI Number | 1700249760
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Entity Type | Organization
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Legal Business Name | ACTIVE RETIREMENT COMMUNITY INC.
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 500 MATHER DR
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-4701
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Country | US
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Telephone | 631-650-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 1 JEFFERSON FERRY DR
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City | SOUTH SETAUKET
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State | NY
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Zip | 11720-4708
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Country | US
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Telephone | 631-650-2600
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | BRIAN AMTMANN
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Credential |
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Telephone | 631-650-2724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 5151317N
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License Number State | NY
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