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General NPI Number Information
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NPI Number | 1780841874
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Entity Type | Organization
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Legal Business Name | THEBRACEDOCTORINC.
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Dates
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Enumeration Date | 05/17/2008
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Last Update Date | 05/17/2008
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Provider Practice Location Address
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Address Line | 305 E 86TH ST 1GW
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City | NEW YORK
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State | NY
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Zip | 10028-4702
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Country | US
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Telephone | 212-592-3272
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Fax | 732-495-6319
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Provider Business Mailing Address
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Address Line | 324 MAIN ST
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City | PORT MONMOUTH
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State | NJ
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Zip | 07758-1046
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Country | US
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Telephone | 908-966-0620
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ORTHOTIST
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Name | MR. PETER WILLIAM VALES
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Credential | C.O.,B.O.C.O.,C.PED.
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Telephone | 908-966-0620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | NY
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