{
"Npi": {
"NPI": "1275841637",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GERIATRIC MEDICAL ASSOCIATES PLLC",
"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": "445 HAMILTON AVE",
"SecondLineMailingAddress": "SUITE 1102",
"MailingAddressCityName": "WHITE PLAINS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10601-1807",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "914-505-6142",
"MailingAddressFaxNumber": "914-560-2108",
"FirstLinePracticeLocationAddress": "445 HAMILTON AVE",
"SecondLinePracticeLocationAddress": "SUITE 1102",
"PracticeLocationAddressCityName": "WHITE PLAINS",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10601-1807",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "914-220-8386",
"PracticeLocationAddressFaxNumber": "914-740-7256",
"EnumerationDate": "09/20/2010",
"LastUpdateDate": "10/17/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CAVALUZZI",
"AuthorizedOfficialFirstName": "PAUL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "914-505-6142",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207QG0300X",
"TaxonomyName": "Geriatric Medicine (Family Medicine) Physician",
"LicenseNumber": "229470",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207QG0300X",
"TaxonomyName": "Geriatric Medicine (Family Medicine) Physician",
"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."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}