{
"Npi": {
"NPI": "1407817992",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LUKOFF",
"FirstName": "PHILIP",
"MiddleName": "FABER",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "D.P.M.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "190 S QUINSIGAMOND AVE APT 203",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHREWSBURY",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01545-4279",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "508-650-3668",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "192 WORCESTER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NATICK",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "01760-2252",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "508-650-3668",
"PracticeLocationAddressFaxNumber": "508-650-1159",
"EnumerationDate": "04/01/2006",
"LastUpdateDate": "05/09/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "1735",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "1735",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "213EP1101X",
"TaxonomyName": "Primary Podiatric Medicine Podiatrist",
"LicenseNumber": "1735",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "1735",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "213ES0131X",
"TaxonomyName": "Foot Surgery Podiatrist",
"LicenseNumber": "1735",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}