{
"Npi": {
"NPI": "1265922462",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DEBENEDETTO",
"FirstName": "JACQUELINE",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HEATH",
"OtherFirstName": "JACQUELINE",
"OtherMiddleName": null,
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3 UNIVERSITY PLZ STE 205",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HACKENSACK",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07601-6208",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "201-833-3000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "718 TEANECK RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TEANECK",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07666-4245",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "201-541-5929",
"PracticeLocationAddressFaxNumber": "201-379-5758",
"EnumerationDate": "05/14/2018",
"LastUpdateDate": "05/05/2025",
"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": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "304028",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "25MA12422000",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}