{
"Npi": {
"NPI": "1053574558",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BARAK PODIATRY,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,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6715 TIPPECANOE RD",
"SecondLineMailingAddress": "SUITE 100, BLDG D",
"MailingAddressCityName": "CANFIELD",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44406-8180",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "330-286-0462",
"MailingAddressFaxNumber": "330-286-0436",
"FirstLinePracticeLocationAddress": "6715 TIPPECANOE RD",
"SecondLinePracticeLocationAddress": "BUILDING D, SUITE 100",
"PracticeLocationAddressCityName": "CANFIELD",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44406-8180",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "330-286-0462",
"PracticeLocationAddressFaxNumber": "330-286-0436",
"EnumerationDate": "07/03/2008",
"LastUpdateDate": "03/22/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BARAK",
"AuthorizedOfficialFirstName": "JOSEPH",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "PODIATRIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "330-360-6545",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "003489",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}