{
"Npi": {
"NPI": "1750379293",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ROY B PETTENGILL AMB ASSOC",
"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": "PO BOX 165",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BRANFORD",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06405-0165",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-663-3634",
"MailingAddressFaxNumber": "860-452-4430",
"FirstLinePracticeLocationAddress": "7 HEBRON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARLBOROUGH",
"PracticeLocationAddressStateName": "CT",
"PracticeLocationAddressPostalCode": "06447-1202",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-295-6219",
"PracticeLocationAddressFaxNumber": "860-295-0604",
"EnumerationDate": "10/10/2005",
"LastUpdateDate": "11/04/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TARKA",
"AuthorizedOfficialFirstName": "LORI",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "860-402-5899",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3416L0300X",
"TaxonomyName": "Land Ambulance",
"LicenseNumber": "C079B1",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}