{
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROSTHETIC AND ORTHOTIC DESIGNS, LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "110 CRYSTAL RUN RD STE 109",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MIDDLETOWN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10941-4004",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "845-703-8134",
"MailingAddressFaxNumber": "845-703-8135",
"FirstLinePracticeLocationAddress": "110 CRYSTAL RUN RD STE 109",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MIDDLETOWN",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "845-703-8134",
"PracticeLocationAddressFaxNumber": "845-703-8135",
"EnumerationDate": "03/25/2017",
"LastUpdateDate": "05/01/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HESS",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": "SCOTT",
"AuthorizedOfficialTitle": "PROSTHETIST ORTHOTIST/PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPO-LPO",
"AuthorizedOfficialTelephoneNumber": "845-480-4391",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "45PO00016200",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}