{
"Npi": {
"NPI": "1174836241",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "Y",
"ParentOrgLBN": "MARC A GOLDBERG, MD PC",
"ParentOrgTIN": null,
"OrgName": "MARC A GOLDBERG MD PC",
"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": "2000 S WHEELING AVE",
"SecondLineMailingAddress": "SUITE 1010",
"MailingAddressCityName": "TULSA",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74104-5649",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-712-3256",
"MailingAddressFaxNumber": "918-712-3263",
"FirstLinePracticeLocationAddress": "2000 S WHEELING AVE",
"SecondLinePracticeLocationAddress": "SUITE 1010",
"PracticeLocationAddressCityName": "TULSA",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "74104-5649",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "918-712-3256",
"PracticeLocationAddressFaxNumber": "918-712-3263",
"EnumerationDate": "07/19/2010",
"LastUpdateDate": "10/29/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOLDBERG",
"AuthorizedOfficialFirstName": "MARC",
"AuthorizedOfficialMiddleName": "ANDREW",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "918-712-3256",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": "332H0000X",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}