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General NPI Number Information
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NPI Number | 1932506847
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Entity Type | Organization
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Legal Business Name | PRIDE REHABILITATIVE SOLUTIONS LLC
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 9546 RIVER RD
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City | MARCY
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State | NY
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Zip | 13403-2073
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Country | US
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Telephone | 732-299-6588
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Fax |
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Provider Business Mailing Address
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Address Line | 24 ELLMORE DR
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City | WHITESBORO
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State | NY
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Zip | 13492-1010
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Country | US
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Telephone | 315-454-7980
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Fax |
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Authorized Official
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Title or Position | COO/PARTNER
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Name | MR. CHAD JASON DEMMA
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Credential |
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Telephone | 315-520-4755
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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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