{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PAIN CENTER NJ PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4359 HIGHWAY 516",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OLD BRIDGE",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07747-2158",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-636-7888",
"MailingAddressFaxNumber": "732-636-7887",
"FirstLinePracticeLocationAddress": "4359 HIGHWAY 516",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MATAWAN",
"PracticeLocationAddressStateName": "NJ",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-636-7888",
"PracticeLocationAddressFaxNumber": "732-636-7887",
"EnumerationDate": "02/11/2014",
"LastUpdateDate": "02/27/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIDDIQUI",
"AuthorizedOfficialFirstName": "ASMA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "732-636-7888",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP3300X",
"TaxonomyName": "Pain Clinic/Center",
"LicenseNumber": "25MA07807000",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}