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General NPI Number Information
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NPI Number | 1801265913
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Entity Type | Organization
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Legal Business Name | VICTOR MARCEANO RN
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 85 CALIFORNIA AVE
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City | MIDDLETOWN
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State | NY
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Zip | 10940-6621
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Country | US
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Telephone | 845-800-4481
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Fax |
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Provider Business Mailing Address
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Address Line | 85 CALIFORNIA AVE
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City | MIDDLETOWN
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State | NY
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Zip | 10940-6621
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Country | US
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Telephone | 808-772-0136
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MR. VICTOR THOMAS MARCEANO
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Credential |
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Telephone | 808-772-0136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | 7032461
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License Number State | NY
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