{
"Npi": {
"NPI": "1629157003",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WIDER",
"FirstName": "TODD",
"MiddleName": "M",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WIDER",
"OtherFirstName": "TODD",
"OtherMiddleName": "M",
"OtherNamePrefix": "MR.",
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "48 ROUTE 25A",
"SecondLineMailingAddress": "202",
"MailingAddressCityName": "SMITHTOWN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11787-1431",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-862-3625",
"MailingAddressFaxNumber": "631-862-3347",
"FirstLinePracticeLocationAddress": "871 5TH AVENUE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10023",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-772-1229",
"PracticeLocationAddressFaxNumber": "212-737-8569",
"EnumerationDate": "11/04/2006",
"LastUpdateDate": "02/18/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2086S0122X",
"TaxonomyName": "Plastic and Reconstructive Surgery Physician",
"LicenseNumber": "193602",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}