{
"Npi": {
"NPI": "1073635421",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BELTZER",
"FirstName": "BLAIR",
"MiddleName": "RICHARD",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "525 UNION BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TOTOWA",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07512-2442",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-953-7668",
"MailingAddressFaxNumber": "973-904-0660",
"FirstLinePracticeLocationAddress": "510 HAMBURG TPKE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WAYNE",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07470-2025",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-953-7668",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/05/2007",
"LastUpdateDate": "02/04/2022",
"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": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "25MA50889",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "25MA05088900",
"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."
}
}
}
}