{
"Npi": {
"NPI": "1295902468",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JESUS PICHARDO MD PC",
"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": "1623 WEIRFIELD STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIDGEWOOD",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11385",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-456-4600",
"MailingAddressFaxNumber": "718-418-3549",
"FirstLinePracticeLocationAddress": "1623 WEIRFIELD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIDGEWOOD",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11385-5349",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-456-4600",
"PracticeLocationAddressFaxNumber": "718-418-3549",
"EnumerationDate": "05/15/2008",
"LastUpdateDate": "04/16/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PICHARDO",
"AuthorizedOfficialFirstName": "JESUS",
"AuthorizedOfficialMiddleName": "MANUEL",
"AuthorizedOfficialTitle": "PEDIATRIC",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "718-456-4600",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "188066",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}