{
"Npi": {
"NPI": "1376280040",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CIVILITY MEDICAL SUPPLIES 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": "155 MAIN STREET.",
"SecondLineMailingAddress": "UNIT 307A",
"MailingAddressCityName": "BREWSTER",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10509",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "845-363-8523",
"MailingAddressFaxNumber": "845-278-1930",
"FirstLinePracticeLocationAddress": "1 PADANARAM RD.",
"SecondLinePracticeLocationAddress": "STE 106",
"PracticeLocationAddressCityName": "DANBURY",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06811",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-678-0438",
"PracticeLocationAddressFaxNumber": "845-278-1930",
"EnumerationDate": "05/16/2022",
"LastUpdateDate": "05/16/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARK",
"AuthorizedOfficialFirstName": "DARYN",
"AuthorizedOfficialMiddleName": "E",
"AuthorizedOfficialTitle": "MANAGING MEMBER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "203-947-6086",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332BN1400X",
"TaxonomyName": "Nursing Facility Supplies (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}