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General NPI Number Information
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NPI Number | 1982010468
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Entity Type | Organization
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Legal Business Name | HEART HEALTH CENTER
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 54 W JIMMIE LEEDS RD SUITE # 14
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City | GALLOWAY
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State | NJ
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Zip | 08205-9438
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Country | US
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Telephone | 609-652-1868
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Fax | 609-423-1990
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Provider Business Mailing Address
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Address Line | 427 E BROOK LN
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City | GALLOWAY
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State | NJ
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Zip | 08205-2920
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Country | US
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Telephone | 609-365-0730
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Fax | 609-423-1990
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Authorized Official
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Title or Position | OWNER
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Name | DR. VIREN VANKAWALA
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Credential | MD
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Telephone | 609-365-0730
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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 | 25MA07979800
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License Number State | NJ
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