NPI Code Detail JSON Logo

1184266256 NPI number — JENNY MARIE PORTUALLO

NPI Number: 1184266256
Health Care Provider/Practitioner: JENNY MARIE PORTUALLO

Information about “1184266256” NPI (JENNY MARIE PORTUALLO) exists in 1184266256 in HTML format HTML  |  1184266256 in plain Text format TXT  |  1184266256 in PDF (Portable Document Format) PDF  |  1184266256 in an XML format XML  formats.

NPI Number : 1184266256 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184266256",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PORTUALLO",
    "FirstName": "JENNY",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MARINO",
    "OtherFirstName": "JENNY",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1 OAKSIDE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SMITHTOWN",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11787-1555",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-672-4185",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1 OAKSIDE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SMITHTOWN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11787-1555",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-672-4185",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/10/2019",
    "LastUpdateDate": "10/10/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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