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General NPI Number Information
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NPI Number | 1780661611
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Entity Type | Individual
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Provider Name | MONA D JUSTO MD
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Gender | Female
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 540 E 11TH ST
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City | BERWICK
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State | PA
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Zip | 18603-2247
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Country | US
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Telephone | 570-752-6641
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Fax | 570-784-5730
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Provider Business Mailing Address
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Address Line | 226 MCADOO AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07305-2014
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Country | US
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Telephone | 201-600-1439
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Fax | 201-451-5017
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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 | 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 | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 20885
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License Number State | WV
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