{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "SHISHKIN PHYSICAL THERAPY REHAB PC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"Credential": null,
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"OtherCredential": null,
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"FirstLineMailingAddress": "7945 GRAND AVE FL 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELMHURST",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11373-4129",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "347-320-0155",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "107 E BROADWAY FL 3",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10002-7037",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-233-0889",
"PracticeLocationAddressFaxNumber": "212-233-0898",
"EnumerationDate": "11/23/2020",
"LastUpdateDate": "11/23/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SHISHKIN",
"AuthorizedOfficialFirstName": "THEDA",
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"AuthorizedOfficialTitle": "PT",
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"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "347-320-0155",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}