{
"Npi": {
"NPI": "1558180075",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EXPRESS IT SPEECH-LANGUAGE PATHOLOGISTS",
"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": "218 COMMONS WAY BLDG B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TOMS RIVER",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08755-6427",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-829-3047",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "218 COMMONS WAY BLDG B",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TOMS RIVER",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08755-6427",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-829-3047",
"PracticeLocationAddressFaxNumber": "732-608-9858",
"EnumerationDate": "10/10/2024",
"LastUpdateDate": "10/21/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLARKE",
"AuthorizedOfficialFirstName": "JENNIFER",
"AuthorizedOfficialMiddleName": "D",
"AuthorizedOfficialTitle": "MANAGING MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PH.D.",
"AuthorizedOfficialTelephoneNumber": "732-288-6825",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QH0700X",
"TaxonomyName": "Hearing and Speech Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}