{
"Npi": {
"NPI": "1063613404",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROBERT A. GRAEBE, M.D., 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": "1131 BROAD ST",
"SecondLineMailingAddress": "104",
"MailingAddressCityName": "SHREWSBURY",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07702-4329",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-460-1073",
"MailingAddressFaxNumber": "732-460-1076",
"FirstLinePracticeLocationAddress": "1131 BROAD ST",
"SecondLinePracticeLocationAddress": "104",
"PracticeLocationAddressCityName": "SHREWSBURY",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07702-4329",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-460-1073",
"PracticeLocationAddressFaxNumber": "732-460-1076",
"EnumerationDate": "05/31/2007",
"LastUpdateDate": "03/07/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRAEBE",
"AuthorizedOfficialFirstName": "NANCY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRACTICE ADM",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "732-460-1073",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207VE0102X",
"TaxonomyName": "Reproductive Endocrinology Physician",
"LicenseNumber": "25MA03861600",
"LicenseNumberStateCode": "NJ",
"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."
}
}
}
}