{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
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"OrgName": "OPTIMUM HEATH & PERFORMANCE",
"LastName": null,
"FirstName": null,
"MiddleName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7001 AMBOY RD",
"SecondLineMailingAddress": "SUITE 202C",
"MailingAddressCityName": "STATEN ISLAND",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10307-1444",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-554-4080",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7001 AMBOY RD",
"SecondLinePracticeLocationAddress": "SUITE 202C",
"PracticeLocationAddressCityName": "STATEN ISLAND",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-554-4080",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/22/2016",
"LastUpdateDate": "07/22/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROMAGNOLO",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "917-709-2025",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": "X012796",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}