{
"Npi": {
"NPI": "1669635397",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTHEAST CORP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherNamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "AVE 1 URB SANTA RITA",
"SecondLineMailingAddress": "OFFICE 304",
"MailingAddressCityName": "VEGA ALTA",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00692-0000",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-270-1345",
"MailingAddressFaxNumber": "787-270-1350",
"FirstLinePracticeLocationAddress": "AVE 1 SANTA RITA",
"SecondLinePracticeLocationAddress": "SUITE 304",
"PracticeLocationAddressCityName": "VEGA ALTA",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00692-0000",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-270-1345",
"PracticeLocationAddressFaxNumber": "787-270-1350",
"EnumerationDate": "07/02/2008",
"LastUpdateDate": "08/26/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SERRANO",
"AuthorizedOfficialFirstName": "JOSE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LIC",
"AuthorizedOfficialTelephoneNumber": "787-594-6383",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": "31",
"LicenseNumberStateCode": "PR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}