{
"Npi": {
"NPI": "1366513194",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MITCHELL J. BLOOM, D.M.D., P.C.",
"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": "880 5TH AVE",
"SecondLineMailingAddress": "SUITE 1-G",
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10021-4951",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-327-2623",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "880 5TH AVE",
"SecondLinePracticeLocationAddress": "SUITE 1-G",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10021-4951",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-327-2623",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/13/2006",
"LastUpdateDate": "07/30/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BLOOM",
"AuthorizedOfficialFirstName": "MITCHELL",
"AuthorizedOfficialMiddleName": "J.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "212-327-3623",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QD0000X",
"TaxonomyName": "Dental Clinic/Center",
"LicenseNumber": "045016",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}