{
"Npi": {
"NPI": "1194162602",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PATEL",
"FirstName": "FORAM",
"MiddleName": "R.",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "19 SAINT PAULS AVE",
"SecondLineMailingAddress": "APT 3",
"MailingAddressCityName": "JERSEY CITY",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07306-1644",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-864-1966",
"MailingAddressFaxNumber": "201-595-0931",
"FirstLinePracticeLocationAddress": "64 FULTON ST",
"SecondLinePracticeLocationAddress": "RM 303",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10038-2756",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-864-1966",
"PracticeLocationAddressFaxNumber": "201-595-0931",
"EnumerationDate": "05/24/2013",
"LastUpdateDate": "06/25/2021",
"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": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "036033",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}