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1073904801 NPI number — AVICENNA MEDICAL CENTER

NPI Number: 1073904801
Health Care Provider/Practitioner: AVICENNA MEDICAL CENTER

Information about “1073904801” NPI (AVICENNA MEDICAL CENTER) exists in 1073904801 in HTML format HTML  |  1073904801 in plain Text format TXT  |  1073904801 in PDF (Portable Document Format) PDF  |  1073904801 in an XML format XML  formats.

NPI Number : 1073904801 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073904801",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "AVICENNA MEDICAL CENTER",
    "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": "129 VALLEY RD",
    "SecondLineMailingAddress": "2ND FLOOR",
    "MailingAddressCityName": "MONTCLAIR",
    "MailingAddressStateName": "NJ",
    "MailingAddressPostalCode": "07042-2331",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "973-746-2620",
    "MailingAddressFaxNumber": "973-746-2579",
    "FirstLinePracticeLocationAddress": "129 VALLEY RD",
    "SecondLinePracticeLocationAddress": "2ND FLOOR",
    "PracticeLocationAddressCityName": "MONTCLAIR",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "07042-2331",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "973-746-2620",
    "PracticeLocationAddressFaxNumber": "973-746-2579",
    "EnumerationDate": "02/16/2015",
    "LastUpdateDate": "02/16/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ROSSI",
    "AuthorizedOfficialFirstName": "ANNA",
    "AuthorizedOfficialMiddleName": "MICHELE",
    "AuthorizedOfficialTitle": "PRESIDENT/PSYCHIATRIST",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.O.",
    "AuthorizedOfficialTelephoneNumber": "973-746-2620",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TP0016X",
        "TaxonomyName": "Prescribing (Medical) Psychologist",
        "LicenseNumber": "25MB07627000",
        "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."
      }
    }
  }
}
                
            

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