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1265123285 NPI number — LAIZ LAURA DE GODOY MD

NPI Number: 1265123285
Health Care Provider/Practitioner: LAIZ LAURA DE GODOY MD

Information about “1265123285” NPI (LAIZ LAURA DE GODOY MD) exists in 1265123285 in HTML format HTML  |  1265123285 in plain Text format TXT  |  1265123285 in PDF (Portable Document Format) PDF  |  1265123285 in an XML format XML  formats.

NPI Number : 1265123285 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265123285",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DE GODOY",
    "FirstName": "LAIZ LAURA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3400 SPRUCE ST",
    "SecondLineMailingAddress": "1 SILVERSTEIN",
    "MailingAddressCityName": "PHILADELPHIA",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19104-4206",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "215-662-3000",
    "MailingAddressFaxNumber": "215-662-7011",
    "FirstLinePracticeLocationAddress": "3400 SPRUCE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PHILADELPHIA",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "19104-4206",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "215-662-3000",
    "PracticeLocationAddressFaxNumber": "215-662-7011",
    "EnumerationDate": "05/19/2023",
    "LastUpdateDate": "07/14/2025",
    "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": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "25MA12625400",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2085R0202X",
          "TaxonomyName": "Diagnostic Radiology Physician",
          "LicenseNumber": "MD489789",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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