{
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"NPI": "1255919684",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TITAN PHYSICAL THERAPY TITAN PT",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "78 HARDING AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TOTOWA",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07512-2502",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-606-5399",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "461 US HIGHWAY 46",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FAIRFIELD",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07004-1954",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-606-5399",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/29/2021",
"LastUpdateDate": "06/02/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MICKULIK",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST, OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "PT, DPT",
"AuthorizedOfficialTelephoneNumber": "570-606-5399",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2251X0800X",
"TaxonomyName": "Orthopedic Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}