{
"Npi": {
"NPI": "1699239715",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MK SPINE AND JOINT REHAB, P.C.",
"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": "500 OLD COUNTRY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GARDEN CITY",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11530-1901",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-757-4466",
"MailingAddressFaxNumber": "631-940-1557",
"FirstLinePracticeLocationAddress": "500 OLD COUNTRY RD STE 300",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GARDEN CITY",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11530-1944",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-335-9935",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/23/2019",
"LastUpdateDate": "01/20/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KALTER",
"AuthorizedOfficialFirstName": "MATTHEW",
"AuthorizedOfficialMiddleName": "HOWARD",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "631-335-9935",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP3300X",
"TaxonomyName": "Pain Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}