{
"Npi": {
"NPI": "1073441614",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SAMUEL",
"FirstName": "BRANDON",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SAMUEL",
"OtherFirstName": "BRANDON",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DPM",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "4424 MILLETT ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19136-2430",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "267-670-3728",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "350 ENGLE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ENGLEWOOD",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07631-1898",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "201-894-3000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/13/2026",
"LastUpdateDate": "05/13/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}