{
"Npi": {
"NPI": "1619541901",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ONE SOURCE SURGICAL SUPPLIES LLC",
"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": "PO BOX 72",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WHITE PLAINS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10602-0072",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "914-948-4878",
"MailingAddressFaxNumber": "866-486-4959",
"FirstLinePracticeLocationAddress": "1 WINCHESTER RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WHITE PLAINS",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10601",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "914-948-4878",
"PracticeLocationAddressFaxNumber": "866-486-4959",
"EnumerationDate": "05/19/2021",
"LastUpdateDate": "01/05/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "THAKER",
"AuthorizedOfficialFirstName": "JAYANT",
"AuthorizedOfficialMiddleName": "K",
"AuthorizedOfficialTitle": "CHIEF EXECUTIVE OFFICER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "R.PH.",
"AuthorizedOfficialTelephoneNumber": "914-948-4878",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332BN1400X",
"TaxonomyName": "Nursing Facility Supplies (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332BX2000X",
"TaxonomyName": "Oxygen Equipment & Supplies (DME)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}