{
"Npi": {
"NPI": "1417459876",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FELDMAN",
"FirstName": "MICHAEL",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "553 S MAPLE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLEN ROCK",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07452-1817",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "609-903-1822",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "94 VALLEY RD FL 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MONTCLAIR",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07042-2211",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "201-731-6244",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/01/2018",
"LastUpdateDate": "01/05/2024",
"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": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "25MP00459100",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "25MP00459100",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "0211611",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "021611",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "25MP00459100",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}