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General NPI Number Information
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NPI Number | 1710224563
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Entity Type | Organization
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Legal Business Name | CENTRO CARE MEDICAL, PC
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 500 OCEAN AVE
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1238
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Country | US
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Telephone | 516-881-7570
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Fax | 516-399-2227
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Provider Business Mailing Address
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Address Line | 500 OCEAN AVE
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1238
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Country | US
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Telephone | 516-881-7570
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Fax | 516-399-2227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHEILA SOMAN
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Credential | M.D.
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Telephone | 516-881-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 214497-1
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License Number State | NY
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