{
"Npi": {
"NPI": "1275873085",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHARLENE CHAO, MD, 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": "802 64TH STREET",
"SecondLineMailingAddress": "STE 2F",
"MailingAddressCityName": "BROOKLYN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11220-5573",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-833-2699",
"MailingAddressFaxNumber": "718-833-2667",
"FirstLinePracticeLocationAddress": "802 64TH STREET",
"SecondLinePracticeLocationAddress": "STE 2F",
"PracticeLocationAddressCityName": "BROOKLYN",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11220-5573",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-833-2699",
"PracticeLocationAddressFaxNumber": "718-833-2667",
"EnumerationDate": "02/15/2013",
"LastUpdateDate": "12/23/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHAO",
"AuthorizedOfficialFirstName": "CHARLENE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "718-833-2699",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "243672",
"LicenseNumberStateCode": "MA",
"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."
}
}
}
}