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General NPI Number Information
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NPI Number | 1982631388
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE NETWORK AT RARITAN BAY INC
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 466 NEW BRUNSWICK AVE
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City | PERTH AMBOY
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State | NJ
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Zip | 08861-3647
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Country | US
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Telephone | 732-324-5140
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 48277
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City | NEWARK
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State | NJ
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Zip | 07101-4800
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Country | US
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Telephone | 201-818-9118
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Fax |
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Authorized Official
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Title or Position | MANAGED CARE
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Name | JOHN HAILPERIN
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Credential |
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Telephone | 201-818-9118
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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 | 25MA07867800
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License Number State | NJ
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