{
"Npi": {
"NPI": "1134279326",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "THE PEDORTHIC SHOPPE INC",
"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 705",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ITASCA",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60143-0705",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "708-453-4900",
"MailingAddressFaxNumber": "708-453-3338",
"FirstLinePracticeLocationAddress": "8344 W LAWRENCE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORRIDGE",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60706-3152",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "708-453-4900",
"PracticeLocationAddressFaxNumber": "708-453-3338",
"EnumerationDate": "01/11/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCAFIDI",
"AuthorizedOfficialFirstName": "MICHELANGELO",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CERTIFIED PEDOTHIST",
"AuthorizedOfficialTelephoneNumber": "708-453-4900",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": "332BC3200X",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}