{
"Npi": {
"NPI": "1629457718",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "OMS PODIATRY SERVICES PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6 OAK CREST DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HIGHLAND",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12528-2708",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-393-7705",
"MailingAddressFaxNumber": "718-446-4547",
"FirstLinePracticeLocationAddress": "10030 DITMARS BLVD RM 325",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAST ELMHURST",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11369-1333",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-393-7705",
"PracticeLocationAddressFaxNumber": "718-446-4547",
"EnumerationDate": "05/22/2015",
"LastUpdateDate": "02/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OGELLE",
"AuthorizedOfficialFirstName": "KELVIN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DPM",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "718-399-7705",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "N005924",
"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."
}
}
}
}