{
"Npi": {
"NPI": "1386001907",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WIGGIES",
"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": "26 ELM RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LK PEEKSKILL",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10537-1416",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "26 ELM RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LK PEEKSKILL",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10537-1416",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "845-430-0944",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/27/2016",
"LastUpdateDate": "01/27/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MONTEBELLO",
"AuthorizedOfficialFirstName": "ANTOINETTE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CO OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CRANIAL PROSTHETICS",
"AuthorizedOfficialTelephoneNumber": "845-430-0944",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "22M00051696",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}