NPI Code Detail JSON Logo

1578921623 NPI number — MARY KATHLEEN MARTIN NURSE PRACTITIONER IN PSYCHIATRY, PLLC

NPI Number: 1578921623
Health Care Provider/Practitioner: MARY KATHLEEN MARTIN NURSE PRACTITIONER IN PSYCHIATRY, PLLC

Information about “1578921623” NPI (MARY KATHLEEN MARTIN NURSE PRACTITIONER IN PSYCHIATRY, PLLC) exists in 1578921623 in HTML format HTML  |  1578921623 in plain Text format TXT  |  1578921623 in PDF (Portable Document Format) PDF  |  1578921623 in an XML format XML  formats.

NPI Number : 1578921623 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578921623",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MARY KATHLEEN MARTIN NURSE PRACTITIONER IN PSYCHIATRY, PLLC",
    "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": "375 W MILL RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MATTITUCK",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11952-2079",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-766-3210",
    "MailingAddressFaxNumber": "631-865-5857",
    "FirstLinePracticeLocationAddress": "21 W 2ND ST",
    "SecondLinePracticeLocationAddress": "SUITE 11",
    "PracticeLocationAddressCityName": "RIVERHEAD",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11901-2752",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-624-7839",
    "PracticeLocationAddressFaxNumber": "631-865-5857",
    "EnumerationDate": "02/04/2016",
    "LastUpdateDate": "02/04/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MARTIN",
    "AuthorizedOfficialFirstName": "MARY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "NP",
    "AuthorizedOfficialTelephoneNumber": "631-766-3210",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TP0016X",
        "TaxonomyName": "Prescribing (Medical) Psychologist",
        "LicenseNumber": "401909",
        "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."
      }
    }
  }
}
                
            

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