{
"Npi": {
"NPI": "1689742694",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DOMINGO",
"FirstName": "GRACE RITA",
"MiddleName": "R",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DOMINGO",
"OtherFirstName": "GRACE",
"OtherMiddleName": "R",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "NP",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "530 1ST AVE",
"SecondLineMailingAddress": "SKI-9R",
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10016-6497",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-263-8177",
"MailingAddressFaxNumber": "212-263-3988",
"FirstLinePracticeLocationAddress": "530 1ST AVE # SKI-9R",
"SecondLinePracticeLocationAddress": "LEON H CHARNEY DIVISION OF CARDIOLOGY",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10016-6402",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-263-8177",
"PracticeLocationAddressFaxNumber": "212-263-3988",
"EnumerationDate": "11/30/2006",
"LastUpdateDate": "07/12/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "334785-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}