{
"Npi": {
"NPI": "1447584859",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PERSONALIZED PREVENTIVE MEDICINE INC",
"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": "2 REEDSDALE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILTON",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02186-3324",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "617-698-0715",
"MailingAddressFaxNumber": "617-698-7559",
"FirstLinePracticeLocationAddress": "2 REEDSDALE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MILTON",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02186-3324",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "617-698-0715",
"PracticeLocationAddressFaxNumber": "617-698-7559",
"EnumerationDate": "10/01/2009",
"LastUpdateDate": "09/01/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DELANY",
"AuthorizedOfficialFirstName": "RICHARD",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "M.D., F.A.C.C",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "617-698-0715",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "44038",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}