{
"Npi": {
"NPI": "1023062502",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "WESTERN CONNECTICUT HEALTH NETWORK, INC.",
"ParentOrgTIN": null,
"OrgName": "WESTERN CONNECTICUT HEALTH NETWORK AFFILIATES, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "24 HOSPITAL AVENUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DANBURY",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06810",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-739-8960",
"MailingAddressFaxNumber": "203-730-9963",
"FirstLinePracticeLocationAddress": "20 GERMANTOWN ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DANBURY",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06810",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-739-8960",
"PracticeLocationAddressFaxNumber": "203-730-9963",
"EnumerationDate": "05/20/2006",
"LastUpdateDate": "07/15/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEBARBA",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "203-739-7240",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0200X",
"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}