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General NPI Number Information
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NPI Number | 1972394773
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Entity Type | Organization
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Legal Business Name | CT PREVENTIVE HEALTH EDGE MEDICAL PC
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 9 W BROAD ST STE 320
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City | STAMFORD
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State | CT
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Zip | 06902-3758
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Country | US
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Telephone | 917-310-5621
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Fax |
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Provider Business Mailing Address
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Address Line | 9 W BROAD ST STE 320
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City | STAMFORD
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State | CT
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Zip | 06902-3758
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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 | COO
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Name | SVEN KARLSSON
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Credential |
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Telephone | 917-310-5621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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