{
"Npi": {
"NPI": "1316120983",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COMPREHENSIVE PODIATRIC CARE CENTER PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2429 BROWN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19130-1930",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-236-4088",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2429 BROWN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PHILADELPHIA",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19130-1930",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-236-4088",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/06/2007",
"LastUpdateDate": "02/04/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DORTONE",
"AuthorizedOfficialFirstName": "KENNETH",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "PODIATRIST",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "215-236-4088",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "SC003609L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}