{
"Npi": {
"NPI": "1669515706",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NEW ENGLAND PODIATRY NEEDHAM, PC",
"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 18743",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BELFAST",
"MailingAddressStateName": "ME",
"MailingAddressPostalCode": "04915-4082",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "617-630-8280",
"MailingAddressFaxNumber": "617-630-9025",
"FirstLinePracticeLocationAddress": "2000 WASHINGTON ST",
"SecondLinePracticeLocationAddress": "GREEN BLDG, STE 470",
"PracticeLocationAddressCityName": "NEWTON",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "02462-1650",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "617-630-8280",
"PracticeLocationAddressFaxNumber": "617-630-9025",
"EnumerationDate": "02/15/2007",
"LastUpdateDate": "04/12/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ETSKOVITZ",
"AuthorizedOfficialFirstName": "RONALD",
"AuthorizedOfficialMiddleName": "BRIAN",
"AuthorizedOfficialTitle": "PODIATRIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "D.P.M.",
"AuthorizedOfficialTelephoneNumber": "617-630-8280",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0131X",
"TaxonomyName": "Foot Surgery Podiatrist",
"LicenseNumber": "1948",
"LicenseNumberStateCode": "MA",
"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."
}
}
}
}