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General NPI Number Information
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NPI Number | 1861949984
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Entity Type | Organization
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Legal Business Name | BEACON INFUSION HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 09/07/2016
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Provider Practice Location Address
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Address Line | 1075 STEPHENSON AVENUE SUITE D-2
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City | OCEANPORT
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State | NJ
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Zip | 07757
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Country | US
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Telephone | 609-450-8872
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Fax | 949-724-3345
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Provider Business Mailing Address
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Address Line | 1075 STEPHENSON AVENUE SUITE D-2
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City | OCEANPORT
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State | NJ
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Zip | 07757
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Country | US
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Telephone | 609-450-8872
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Fax | 949-724-3345
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | DERRICK JOHNSON
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Credential |
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Telephone | 917-882-1835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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