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General NPI Number Information
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NPI Number | 1801944921
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Entity Type | Individual
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Provider Name | PETER GOULD M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 50 NEWARK AVE SUITE 308
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1185
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Country | US
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Telephone | 973-450-1155
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Fax | 973-751-5741
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Provider Business Mailing Address
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Address Line | PO BOX 922
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City | NEW PROVIDENCE
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State | NJ
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Zip | 07974-0922
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Country | US
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Telephone | 973-450-1155
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Fax | 973-751-5741
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MA59754
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License Number State | NJ
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