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1114304458 NPI number — SUS

NPI Number: 1114304458
Health Care Provider/Practitioner: SUS

Information about “1114304458” NPI (SUS) exists in 1114304458 in HTML format HTML  |  1114304458 in plain Text format TXT  |  1114304458 in PDF (Portable Document Format) PDF  |  1114304458 in an XML format XML  formats.

NPI Number : 1114304458 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114304458",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SUS",
    "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": "170 E 107TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEW YORK",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10029-3905",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "212-722-7507",
    "MailingAddressFaxNumber": "212-722-7583",
    "FirstLinePracticeLocationAddress": "170 E 107TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEW YORK",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10029-3905",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "212-722-7507",
    "PracticeLocationAddressFaxNumber": "212-722-7583",
    "EnumerationDate": "05/06/2015",
    "LastUpdateDate": "05/06/2015",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "WIERBICKI",
    "AuthorizedOfficialFirstName": "LAURA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PROGRAM MANAGER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LMSW",
    "AuthorizedOfficialTelephoneNumber": "212-722-7507",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "324500000X",
        "TaxonomyName": "Substance Abuse Rehabilitation Facility",
        "LicenseNumber": "150511551",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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