{
"Npi": {
"NPI": "1407171093",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ENISMAN FREEDMAN SEPULVEDA PLASTIC SURGEONS PC",
"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": "207 WASHINGTON ST",
"SecondLineMailingAddress": "SUITE 203A",
"MailingAddressCityName": "POUGHKEEPSIE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12601-1356",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "845-471-0800",
"MailingAddressFaxNumber": "845-471-0863",
"FirstLinePracticeLocationAddress": "207 WASHINGTON ST",
"SecondLinePracticeLocationAddress": "SUITE 203A",
"PracticeLocationAddressCityName": "POUGHKEEPSIE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12601-1356",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "845-471-0800",
"PracticeLocationAddressFaxNumber": "845-471-0863",
"EnumerationDate": "04/07/2010",
"LastUpdateDate": "04/07/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SEPULVEDA",
"AuthorizedOfficialFirstName": "CELESTINO",
"AuthorizedOfficialMiddleName": "EDDIE",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "914-204-7056",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "172205-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}