{
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"OrgName": "RIVER PRIMARY CARE CENTER, INC",
"LastName": null,
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"NameSuffix": null,
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"FirstLineMailingAddress": "2809 RIVER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAMDEN",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08105-4426",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "856-966-8088",
"MailingAddressFaxNumber": "856-966-8089",
"FirstLinePracticeLocationAddress": "2809 RIVER RD",
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"PracticeLocationAddressCityName": "CAMDEN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "856-966-8088",
"PracticeLocationAddressFaxNumber": "856-966-8089",
"EnumerationDate": "09/19/2007",
"LastUpdateDate": "09/19/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ERVILUS",
"AuthorizedOfficialFirstName": "PATRICK",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "FAMILY NURSE PRACTITIONER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NPC",
"AuthorizedOfficialTelephoneNumber": "856-966-8088",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "163WG0000X",
"TaxonomyName": "General Practice Registered Nurse",
"LicenseNumber": "26NN10322000",
"LicenseNumberStateCode": "NJ",
"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."
}
}
}
}