1740580638 NPI number — LYNNETTE MARGARET DAGROSA M.A.,O.T.R./L

NPI Number: 1740580638
Health Care Provider/Practitioner: LYNNETTE MARGARET DAGROSA M.A.,O.T.R./L

NPI Number : 1740580638 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740580638",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DAGROSA",
    "FirstName": "LYNNETTE",
    "MiddleName": "MARGARET",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "M.A.,O.T.R./L",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DAGROSA",
    "OtherFirstName": "MATTHEW",
    "OtherMiddleName": "ANTHONY",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "OTR",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "154 CARROLL ST APT D3",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROOKLYN",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11231-3540",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "718-522-2748",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "154 CARROLL ST APT D3",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BROOKLYN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11231-3540",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "718-522-2748",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/26/2010",
    "LastUpdateDate": "10/26/2010",
    "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": "174400000X",
        "TaxonomyName": "Specialist",
        "LicenseNumber": "0021481",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}