{
"Npi": {
"NPI": "1144317918",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROSTHETICS BY NELSON, INC.",
"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": "2959 GENESEE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHEEKTOWAGA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14225-2653",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-894-6666",
"MailingAddressFaxNumber": "716-894-1858",
"FirstLinePracticeLocationAddress": "220 RED TAIL RD STE 10",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ORCHARD PARK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14127-1599",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-675-0001",
"PracticeLocationAddressFaxNumber": "716-675-8082",
"EnumerationDate": "10/05/2006",
"LastUpdateDate": "05/19/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOJCIK",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPO",
"AuthorizedOfficialTelephoneNumber": "716-894-6666",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}