{
"Npi": {
"NPI": "1023286762",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MODERN REHABILITATION TECHNOLOGIES, 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": "329 MIDDLE COUNTRY RD",
"SecondLineMailingAddress": "SUITE 2",
"MailingAddressCityName": "SMITHTOWN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11787-2830",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-360-6400",
"MailingAddressFaxNumber": "631-360-6449",
"FirstLinePracticeLocationAddress": "430 TONEY PENNA DR",
"SecondLinePracticeLocationAddress": "SUITE 6",
"PracticeLocationAddressCityName": "JUPITER",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33458-5775",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "561-748-5657",
"PracticeLocationAddressFaxNumber": "561-748-5658",
"EnumerationDate": "02/15/2008",
"LastUpdateDate": "02/15/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHWING",
"AuthorizedOfficialFirstName": "WILLIAM",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPO, LPO, BOCPO",
"AuthorizedOfficialTelephoneNumber": "561-748-5657",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "POR 170",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}