{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "EMPIRE TECH SUPPLIES, CORP.",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6555 NW 36TH ST",
"SecondLineMailingAddress": "SUITE 206",
"MailingAddressCityName": "VIRGINIA GARDENS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33166-6978",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6555 NW 36TH ST",
"SecondLinePracticeLocationAddress": "SUITE 206",
"PracticeLocationAddressCityName": "VIRGINIA GARDENS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33166-6978",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-871-5113",
"PracticeLocationAddressFaxNumber": "305-870-0179",
"EnumerationDate": "01/25/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PICHS",
"AuthorizedOfficialFirstName": "DANIEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "305-871-5113",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "PENDING LICENSE #",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}