{
"Npi": {
"NPI": "1114151685",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "LOURDES MEDICAL ASSOCIATES, P. A.",
"ParentOrgTIN": null,
"OrgName": "LOURDES MEDICAL ASSOCIATES, P. A.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "500 GROVE ST",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "HADDON HEIGHTS",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08035-1736",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "856-796-9200",
"MailingAddressFaxNumber": "856-310-5603",
"FirstLinePracticeLocationAddress": "811 SUNSET RD",
"SecondLinePracticeLocationAddress": "SUITE 201",
"PracticeLocationAddressCityName": "BURLINGTON",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08016-3645",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "609-298-1776",
"PracticeLocationAddressFaxNumber": "609-531-2391",
"EnumerationDate": "05/12/2009",
"LastUpdateDate": "03/13/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FOX",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "856-796-9200",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207RP1001X",
"TaxonomyName": "Pulmonary Disease Physician",
"LicenseNumber": "25MA05310200",
"LicenseNumberStateCode": "NJ",
"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."
}
}
}
}