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General NPI Number Information
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NPI Number | 1730550971
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Entity Type | Organization
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Legal Business Name | SUPREME THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 116 W 23RD ST STE 5-552
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City | NEW YORK
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State | NY
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Zip | 10011-2599
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Country | US
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Telephone | 917-628-3767
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Fax | 718-231-1913
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Provider Business Mailing Address
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Address Line | 116 W 23RD ST STE 5-552
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City | NEW YORK
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State | NY
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Zip | 10011-2599
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Country | US
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Telephone | 917-628-3767
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Fax | 718-231-1913
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Authorized Official
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Title or Position | OWNER
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Name | ERIC CHIFUNDA
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Credential |
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Telephone | 917-628-3767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 019090-1
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License Number State | NY
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