{
"Npi": {
"NPI": "1124172747",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DWIGHT C. BLUM M.D. P.L.L.C.",
"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": "PO BOX 5111",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BAY SHORE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11706-0084",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-789-1150",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "365 BROADWAY",
"SecondLinePracticeLocationAddress": "SUITE 4",
"PracticeLocationAddressCityName": "AMITYVILLE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11701-2716",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-789-1150",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/22/2007",
"LastUpdateDate": "03/20/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLUM",
"AuthorizedOfficialFirstName": "DWIGHT",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "631-789-1150",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}