{
"Npi": {
"NPI": "1063068823",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "STOLL",
"FirstName": "CHELSEA",
"MiddleName": "ANNA MARIE",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "200 S ORANGE AVE STE 170",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LIVINGSTON",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07039-5817",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-727-9275",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 S ORANGE AVE STE 170",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LIVINGSTON",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07039-5817",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-727-9275",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/16/2019",
"LastUpdateDate": "06/20/2024",
"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": "2082S0105X",
"TaxonomyName": "Surgery of the Hand (Plastic Surgery) Physician",
"LicenseNumber": "25MP00537600",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "208200000X",
"TaxonomyName": "Plastic Surgery Physician",
"LicenseNumber": "25MP00537600",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2082S0099X",
"TaxonomyName": "Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician",
"LicenseNumber": "25MP00537600",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}