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General NPI Number Information
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NPI Number | 1992315337
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Entity Type | Organization
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Legal Business Name | JAYSON MOBILE CARE PHLEBOTOMIST LLC
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 80 CORBIN AVE
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City | JERSEY CITY
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State | NJ
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Zip | 07306-6914
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Country | US
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Telephone | 973-866-7453
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Fax | 973-528-2558
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Provider Business Mailing Address
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Address Line | 182 LITTLE ST
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City | BELLEVILLE
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State | NJ
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Zip | 07109-2629
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Country | US
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Telephone | 973-820-7681
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Fax | 973-528-2558
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Authorized Official
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Title or Position | OWNER
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Name | SHAKTI D MANBODE
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Credential | CEO
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Telephone | 973-820-7681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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