{
"Npi": {
"NPI": "1457793291",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MGDA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "146 HIGHLAND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WATERBURY",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06708-2761",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-755-7748",
"MailingAddressFaxNumber": "203-755-7784",
"FirstLinePracticeLocationAddress": "146 HIGHLAND AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WATERBURY",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06708-2761",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-755-7748",
"PracticeLocationAddressFaxNumber": "203-755-7784",
"EnumerationDate": "07/22/2013",
"LastUpdateDate": "07/22/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREENWALD",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "203-755-7748",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "007481",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}