{
"Npi": {
"NPI": "1588913594",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ROSA",
"FirstName": "MICHELLE",
"MiddleName": "T",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "PA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "18 DALE LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HAUPPAUGE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11788-4330",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-487-7084",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "NEW YORK SPINE AND BRAIN SURGERY",
"SecondLinePracticeLocationAddress": "HSC T12 RM 080",
"PracticeLocationAddressCityName": "STONY BROOK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11794-8122",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-444-1116",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/05/2012",
"LastUpdateDate": "05/06/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "015933-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}