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General NPI Number Information
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NPI Number | 1770665341
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Entity Type | Individual
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Provider Name | MICHAEL MAMMON
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25 POCONO RD
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City | DENVILLE
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State | NJ
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Zip | 07834-2954
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Country | US
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Telephone | 973-625-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 ADAMS ST APT 406
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City | HOBOKEN
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State | NJ
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Zip | 07030-2221
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Country | US
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Telephone | 201-963-9211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MP-529
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License Number State | NJ
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