{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "JOHNSON UPPER EXTREMITY OT SERVICES, PC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"FirstLineMailingAddress": "PO BOX 237046",
"SecondLineMailingAddress": "ANSONIA STATION",
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10023-0028",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-721-0460",
"MailingAddressFaxNumber": "646-559-2792",
"FirstLinePracticeLocationAddress": "160 W 66TH ST",
"SecondLinePracticeLocationAddress": "SUITE 37-J",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10023-6555",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-721-0460",
"PracticeLocationAddressFaxNumber": "646-559-2792",
"EnumerationDate": "10/18/2006",
"LastUpdateDate": "09/25/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JOHNSON",
"AuthorizedOfficialFirstName": "CARYL",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "O.T., C.H.T.",
"AuthorizedOfficialTelephoneNumber": "212-721-0460",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225X00000X",
"TaxonomyName": "Occupational Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}