{
"Npi": {
"NPI": "1144716374",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ORTHOPEDIC SURGERY AND SPORTS MEDICINE OF NEW YORK, PLLC",
"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": "1088 N BROADWAY FL 1",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "YONKERS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10701-1107",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "917-727-7646",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "984 N BROADWAY STE 306",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "YONKERS",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10701-1308",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "917-727-7646",
"PracticeLocationAddressFaxNumber": "914-612-7883",
"EnumerationDate": "07/11/2018",
"LastUpdateDate": "04/20/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEHTA",
"AuthorizedOfficialFirstName": "VISHAL",
"AuthorizedOfficialMiddleName": "A.",
"AuthorizedOfficialTitle": "FOUNDING PARTNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "914-369-1700",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}