{
"Npi": {
"NPI": "1306544473",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JEAN",
"FirstName": "GARY",
"MiddleName": "C.",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MSN, PMHNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "600 STATION DR APT 625",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AVENEL",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07001-1868",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "347-824-5767",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "233 MOUNT AIRY RD STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BASKING RIDGE",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07920-2338",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-304-5695",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/20/2023",
"LastUpdateDate": "10/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "F405456-01",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "APRN11024714",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "26NJ01463500",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}