{
"Npi": {
"NPI": "1548544620",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "FUNCTIONAL LIFE ACHIEVEMENT",
"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": "161 MADISON AVE",
"SecondLineMailingAddress": "2ND FLOOR",
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10016-5421",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-683-8905",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "161 MADISON AVE",
"SecondLinePracticeLocationAddress": "2ND FLOOR",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10016-5421",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-683-8905",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/06/2011",
"LastUpdateDate": "10/06/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARISI-ELLIS",
"AuthorizedOfficialFirstName": "PHYLLIS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ED SUPERVISOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "718-886-6456",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "252Y00000X",
"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": "2305418",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}