{
"Npi": {
"NPI": "1609089523",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JEFFERSON PROSTHETIC & ORTHOTIC COMPANY, INC.",
"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": "120 PROSPECT ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTH ORANGE",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07079-2103",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-762-0780",
"MailingAddressFaxNumber": "973-762-1480",
"FirstLinePracticeLocationAddress": "120 PROSPECT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTH ORANGE",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07079-2103",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-762-0780",
"PracticeLocationAddressFaxNumber": "973-762-1480",
"EnumerationDate": "05/07/2007",
"LastUpdateDate": "10/05/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHANG",
"AuthorizedOfficialFirstName": "SIMON",
"AuthorizedOfficialMiddleName": "C. W.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "C.P.O.",
"AuthorizedOfficialTelephoneNumber": "973-762-0780",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "45PO00002400",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}