{
"Npi": {
"NPI": "1225243876",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "METROPOLITAN MEDICAL TRANSPORTATION IPA, LLC",
"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": "992 S 2ND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RONKONKOMA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11779-7204",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-389-2098",
"MailingAddressFaxNumber": "631-389-2459",
"FirstLinePracticeLocationAddress": "2950 EXPRESS DR S STE 240",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ISLANDIA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11749-1412",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-389-2098",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/14/2007",
"LastUpdateDate": "09/13/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WINAKOR",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "516-807-9324",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "347E00000X",
"TaxonomyName": "Transportation Broker",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}