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General NPI Number Information
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NPI Number | 1881139343
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Entity Type | Organization
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Legal Business Name | PERSIST HEALTHCARE CORP
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 2 LAWSON AVE SUITE 2
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1700
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Country | US
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Telephone | 866-473-7747
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 CORDOVA RD SUITE 210
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2115
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Country | US
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Telephone | 866-473-7747
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDWARD J LAKE
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Credential |
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Telephone | 866-473-7748
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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 |
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