{
"Npi": {
"NPI": "1740695717",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MARINO D. TAVAREZ, MD, MPH PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "150 JAY ST",
"SecondLineMailingAddress": "FINGER LAKES FAMILY MEDICINE",
"MailingAddressCityName": "GENEVA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14456-3212",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "315-759-5426",
"MailingAddressFaxNumber": "585-486-1634",
"FirstLinePracticeLocationAddress": "150 JAY ST",
"SecondLinePracticeLocationAddress": "FINGER LAKES FAMILY MEDICINE",
"PracticeLocationAddressCityName": "GENEVA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14456-3212",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "315-759-5426",
"PracticeLocationAddressFaxNumber": "585-486-1634",
"EnumerationDate": "06/27/2014",
"LastUpdateDate": "01/05/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAVAREZ",
"AuthorizedOfficialFirstName": "MARINO",
"AuthorizedOfficialMiddleName": "DE JESUS",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "908-400-1843",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "232852",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}