{
"Npi": {
"NPI": "1013018365",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BAYSHORE WOUND CARE CENTER",
"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": "24 N LAKE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDDLETOWN",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07748-2347",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-977-4211",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1 BETHANY RD",
"SecondLinePracticeLocationAddress": "BUILDING 3, SUITE 41",
"PracticeLocationAddressCityName": "HAZLET",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07730-1663",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-203-9780",
"PracticeLocationAddressFaxNumber": "732-203-9781",
"EnumerationDate": "09/26/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WEISSMAN",
"AuthorizedOfficialFirstName": "ROSE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "NP",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "FNP",
"AuthorizedOfficialTelephoneNumber": "732-977-4211",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "314000000X",
"TaxonomyName": "Skilled Nursing Facility",
"LicenseNumber": "26NJ00040900",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}