{
"Npi": {
"NPI": "1386984243",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUMMIT DENTAL GROUP RIVERDALE LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "860 MEADOW LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRANKLIN LAKES",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07417-1112",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-342-1233",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "92 STATE RT 23",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVERDALE",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07457-1203",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "201-891-7400",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/28/2013",
"LastUpdateDate": "02/28/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LORINO",
"AuthorizedOfficialFirstName": "ROBERT",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MEMBER/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.M.D.",
"AuthorizedOfficialTelephoneNumber": "973-342-1233",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "22DI02152600",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "22DI02140400",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}