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General NPI Number Information
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NPI Number | 1720871635
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Entity Type | Organization
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Legal Business Name | CCG MEDICAL GROUP LLC
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 433 CENTRAL AVE
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City | WESTFIELD
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State | NJ
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Zip | 07090-2520
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Country | US
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Telephone | 973-759-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 673 MORRIS AVE STE 201
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-1512
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING BUSINESS PARTNER
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Name | CLIFFORD M SALES
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Credential | MD
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Telephone | 973-759-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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