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General NPI Number Information
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NPI Number | 1750872719
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Entity Type | Organization
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Legal Business Name | PATERSON CHIROPRACTIC AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 345 BROADWAY FL 1
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City | PATERSON
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State | NJ
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Zip | 07501-2102
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Country | US
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Telephone | 973-345-2800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 503
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-0503
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Country | US
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Telephone | 973-345-2800
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Fax | 973-345-2807
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL MANNO
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Credential | DC
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Telephone | 973-345-2800
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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 | 38MC0052900
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License Number State | NJ
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | $$$$$$$$$
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | SOCIAL SECURITY
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Identifier #2
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Identifier Code | 138687079
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | SOCIAL SECURITY
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