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General NPI Number Information
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NPI Number | 1922170646
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Entity Type | Organization
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Legal Business Name | PIERRE RENELIQUE MD PC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 870 CENTRAL AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4660
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Country | US
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Telephone | 718-466-4772
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Fax |
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Provider Business Mailing Address
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Address Line | 714 CENTRAL AVE
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City | WOODMERE
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State | NY
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Zip | 11598-2613
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | PIERRE RENELIQUE
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Credential |
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Telephone | 718-466-4772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1813491
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License Number State | NY
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