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General NPI Number Information
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NPI Number | 1942770425
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Entity Type | Organization
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Legal Business Name | CENTER FOR INNOVATIVE GYN CARE NE LLC
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 325 CLAREMONT AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042
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Country | US
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Telephone | 301-603-2622
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Fax |
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Provider Business Mailing Address
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Address Line | 3206 TOWER OAKS BLVD STE 200
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City | ROCKVILLE
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State | MD
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Zip | 20852-4253
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Country | US
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Telephone | 301-603-2622
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Fax | 301-664-6475
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | THOMAS S FINLEY
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Credential |
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Telephone | 301-603-2622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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