{
"Npi": {
"NPI": "1306089792",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WELLNESS CONSULTATION SERVICES LLC",
"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": "6 ASPEN CT",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAST BRUNSWICK",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08816-3345",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-816-1651",
"MailingAddressFaxNumber": "732-238-9509",
"FirstLinePracticeLocationAddress": "8 OLD BRIDGE TPKE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTH RIVER",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08882-2400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-390-4888",
"PracticeLocationAddressFaxNumber": "732-390-0255",
"EnumerationDate": "04/14/2009",
"LastUpdateDate": "04/14/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DUBOV",
"AuthorizedOfficialFirstName": "BETSY",
"AuthorizedOfficialMiddleName": "ROCHELLE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "REGISTERED DIETITIAN",
"AuthorizedOfficialTelephoneNumber": "732-816-1651",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": "00634638",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}