{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "ABRAHAM MITTELMAN, MD, LLC",
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"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3010 WESTCHESTER AVE",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "PURCHASE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10577-2535",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "914-701-0001",
"MailingAddressFaxNumber": "914-701-0002",
"FirstLinePracticeLocationAddress": "3010 WESTCHESTER AVE",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "PURCHASE",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "914-701-0001",
"PracticeLocationAddressFaxNumber": "914-701-0002",
"EnumerationDate": "07/23/2007",
"LastUpdateDate": "06/11/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MITTELMAN",
"AuthorizedOfficialFirstName": "ABRAHAM",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "914-681-0025",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "136251",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}