{
"Npi": {
"NPI": "1043628068",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MCNULTY",
"FirstName": "JILLIAN",
"MiddleName": "ROSE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "P.A.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SPALLINA",
"OtherFirstName": "JILLIAN",
"OtherMiddleName": "ROSE",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "P.A.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "480 SOUTH BEDFORD ROAD",
"SecondLineMailingAddress": "PRE-SURGICAL TESTING BUILDING C",
"MailingAddressCityName": "CHAPPAQUA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10514",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "914-458-8850",
"MailingAddressFaxNumber": "914-458-8764",
"FirstLinePracticeLocationAddress": "480 SOUTH BEDFORD ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHAPPAQUA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10514",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "914-458-8863",
"PracticeLocationAddressFaxNumber": "914-458-8764",
"EnumerationDate": "07/23/2014",
"LastUpdateDate": "01/12/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "017781",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}