NPI Code Detail JSON Logo

1366312670 NPI number — PETER THE GREAT II LLC

NPI Number: 1366312670
Health Care Provider/Practitioner: PETER THE GREAT II LLC

Information about “1366312670” NPI (PETER THE GREAT II LLC) exists in 1366312670 in HTML format HTML  |  1366312670 in plain Text format TXT  |  1366312670 in PDF (Portable Document Format) PDF  |  1366312670 in an XML format XML  formats.

NPI Number : 1366312670 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366312670",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PETER THE GREAT II LLC",
    "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": "1722 MADISON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HOLLYWOOD",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33020-5537",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-923-1726",
    "MailingAddressFaxNumber": "954-923-8535",
    "FirstLinePracticeLocationAddress": "1722 MADISON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HOLLYWOOD",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33020-5537",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-923-1726",
    "PracticeLocationAddressFaxNumber": "954-923-8535",
    "EnumerationDate": "11/11/2025",
    "LastUpdateDate": "11/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "AVERBUKH",
    "AuthorizedOfficialFirstName": "LEONID",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "917-913-9966",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "3104A0625X",
        "TaxonomyName": "Assisted Living Facility (Mental Illness)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.