{
"Npi": {
"NPI": "1194094839",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DYNAMIC CARE OT, PT, SLP 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": "7540 AUSTIN ST",
"SecondLineMailingAddress": "3GR",
"MailingAddressCityName": "FOREST HILLS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11375-6248",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-286-9212",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7540 AUSTIN ST",
"SecondLinePracticeLocationAddress": "3GR",
"PracticeLocationAddressCityName": "FOREST HILLS",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11375-6248",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-286-9212",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/27/2011",
"LastUpdateDate": "05/11/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAVILA",
"AuthorizedOfficialFirstName": "JOSE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT,MPH",
"AuthorizedOfficialTelephoneNumber": "718-286-9212",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "021147",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}