{
"Npi": {
"NPI": "1467641209",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GRZEGORZ WOLSKI PT PC",
"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": "11115 75TH AVE",
"SecondLineMailingAddress": "SUITE 40",
"MailingAddressCityName": "FOREST HILLS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11375-6327",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "917-723-5824",
"MailingAddressFaxNumber": "718-575-0520",
"FirstLinePracticeLocationAddress": "7002 FRESH POND RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIDGEWOOD",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11385-5902",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-381-3373",
"PracticeLocationAddressFaxNumber": "718-381-3378",
"EnumerationDate": "10/17/2007",
"LastUpdateDate": "07/01/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WOLSKI",
"AuthorizedOfficialFirstName": "GRZEGORZ",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "917-723-5824",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "023168",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}