{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HAWTHORNE PEDIATRICS, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "330 LAFAYETTE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAWTHORNE",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07506-2506",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-841-5112",
"MailingAddressFaxNumber": "973-826-5064",
"FirstLinePracticeLocationAddress": "330 LAFAYETTE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HAWTHORNE",
"PracticeLocationAddressStateName": "NJ",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-841-5112",
"PracticeLocationAddressFaxNumber": "973-826-5064",
"EnumerationDate": "08/03/2015",
"LastUpdateDate": "08/05/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "VASENA MARENGO",
"AuthorizedOfficialFirstName": "MARIA",
"AuthorizedOfficialMiddleName": "JOSE",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "973-841-5112",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "25MA09694700",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}