{
"Npi": {
"NPI": "1346645033",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ICONIC IMAGING, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "815 SE 1ST AVE STE B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HALLANDALE BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33009-7102",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-773-9598",
"MailingAddressFaxNumber": "954-773-9588",
"FirstLinePracticeLocationAddress": "150 SW 12TH AVE STE 101B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "POMPANO BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33069-3298",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-773-9598",
"PracticeLocationAddressFaxNumber": "954-773-9588",
"EnumerationDate": "10/24/2014",
"LastUpdateDate": "10/24/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHAKED",
"AuthorizedOfficialFirstName": "SAGI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "954-773-9598",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0200X",
"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}