{
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"IsOrgSubpart": "N",
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"OrgName": "SHIVENDRA PANDEY MD PC",
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"FirstLineMailingAddress": "19 FULLING MILL LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COLTS NECK",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07722-1278",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-223-0008",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2640 HIGHWAY 70",
"SecondLinePracticeLocationAddress": "SUITE 101B BUILDING 12",
"PracticeLocationAddressCityName": "MANASQUAN",
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"PracticeLocationAddressTelephoneNumber": "732-223-0008",
"PracticeLocationAddressFaxNumber": "732-223-8020",
"EnumerationDate": "09/25/2009",
"LastUpdateDate": "09/25/2009",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PANDEY",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "732-735-5455",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "MA66691",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}