{
"Npi": {
"NPI": "1164872669",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ILLARI PHYSCIAL THERAPY P.C.",
"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": "51 CLEREMONT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT JAMES",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11780-1708",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-447-2315",
"MailingAddressFaxNumber": "631-447-2297",
"FirstLinePracticeLocationAddress": "2314 N OCEAN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FARMINGVILLE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11738-2915",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-438-0400",
"PracticeLocationAddressFaxNumber": "631-438-0401",
"EnumerationDate": "06/15/2016",
"LastUpdateDate": "05/10/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ILLARI",
"AuthorizedOfficialFirstName": "MEGAN",
"AuthorizedOfficialMiddleName": "B",
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "631-252-1512",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "018220",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}