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General NPI Number Information
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NPI Number | 1821283409
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Entity Type | Organization
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Legal Business Name | DEBORAH A. DEROSE, D.P.M.
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 880 OLD POST RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-8403
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Country | US
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Telephone | 203-255-9975
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Fax |
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Provider Business Mailing Address
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Address Line | 880 OLD POST RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-8403
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Country | US
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Telephone | 203-255-9975
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Fax |
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Authorized Official
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Title or Position | SPOUSE
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Name | ALVIN SAUL PRUSOFF
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Credential |
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Telephone | 203-255-9975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 000304
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License Number State | CT
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