{
"Npi": {
"NPI": "1326299371",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TAMAYO PHYSICAL THERAPY P.C.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "354 RUSSELL AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EDGEWATER",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07020-3133",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-977-9548",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "30 E 65TH ST",
"SecondLinePracticeLocationAddress": "SUITE 4A",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10065-7013",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-535-2621",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/08/2008",
"LastUpdateDate": "09/24/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VILLANUEVA-FISCHBERG",
"AuthorizedOfficialFirstName": "GEZEL",
"AuthorizedOfficialMiddleName": "TAMAYO",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS, PT",
"AuthorizedOfficialTelephoneNumber": "646-977-9548",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "010519-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}