{
"Npi": {
"NPI": "1003671199",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "PRAMUKH MEDICAL SERVICES LLC",
"ParentOrgTIN": null,
"OrgName": "PRAMUKH MEDICAL SERVICES LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3 WATERS EDGE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DELRAN",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08075-1895",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "856-444-8405",
"MailingAddressFaxNumber": "856-444-8418",
"FirstLinePracticeLocationAddress": "1747 HOOPER AVE STE 15",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TOMS RIVER",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08753-8165",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-228-7273",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/16/2024",
"LastUpdateDate": "02/16/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATEL",
"AuthorizedOfficialFirstName": "CHIRAG",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "856-266-2853",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}