{
"Npi": {
"NPI": "1134358203",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BERTINI",
"FirstName": "MARIA",
"MiddleName": "THERESA",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.O.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GAVIN",
"OtherFirstName": "MARIA",
"OtherMiddleName": "THERESA",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DO",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "346 GRAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JOHNSON CITY",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13790-2580",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "607-729-8156",
"MailingAddressFaxNumber": "607-729-3982",
"FirstLinePracticeLocationAddress": "4417 VESTAL PARKWAY EAST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "VESTAL",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "13850-3556",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "607-770-7365",
"PracticeLocationAddressFaxNumber": "607-729-5882",
"EnumerationDate": "07/09/2009",
"LastUpdateDate": "09/27/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "264159",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}