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General NPI Number Information
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NPI Number | 1881855278
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Entity Type | Organization
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Legal Business Name | NEWARK PRIME CARE,LLC
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 337 BLOOMFIELD AVE # A-2
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City | NEWARK
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State | NJ
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Zip | 07107-2405
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Country | US
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Telephone | 973-497-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 337 BLOOMFIELD AVE # A-2
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City | NEWARK
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State | NJ
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Zip | 07107-2405
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Country | US
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Telephone | 973-497-2424
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | VIVIANE ACKAD
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Credential |
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Telephone | 973-497-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MA67816
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License Number State | NJ
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