{
"Npi": {
"NPI": "1508168212",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FIVE S & A REHAB P.T. P.C.",
"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": "14434 HILLSIDE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JAMAICA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11435-3324",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "347-869-3817",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "14434 HILLSIDE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JAMAICA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11435-3324",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "347-869-3817",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/01/2010",
"LastUpdateDate": "12/01/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELAMAWAY",
"AuthorizedOfficialFirstName": "SHABAN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "347-869-3817",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "019816",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}