{
"Npi": {
"NPI": "1700216256",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "GREENLINE DIAGNOSTICS",
"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": "971 N LA CIENEGA BLVD",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "LOS ANGELES",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "90069-4790",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-602-9116",
"MailingAddressFaxNumber": "310-943-1727",
"FirstLinePracticeLocationAddress": "971 N LA CIENEGA BLVD",
"SecondLinePracticeLocationAddress": "SUITE 202",
"PracticeLocationAddressCityName": "LOS ANGELES",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "90069-4790",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "310-602-9116",
"PracticeLocationAddressFaxNumber": "310-943-1727",
"EnumerationDate": "11/20/2013",
"LastUpdateDate": "11/20/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KIRZHNER",
"AuthorizedOfficialFirstName": "EUGENY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "310-602-9116",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "293D00000X",
"TaxonomyName": "Physiological Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}