{
"Npi": {
"NPI": "1750680393",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EAST BRUNSWICK PRIMARY CARE, PA",
"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": "15 TIMBER RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EDISON",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08820-3204",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-603-0055",
"MailingAddressFaxNumber": "732-603-8228",
"FirstLinePracticeLocationAddress": "F1 BRIER HILL CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAST BRUNSWICK",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08816-3337",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-603-0055",
"PracticeLocationAddressFaxNumber": "732-603-8228",
"EnumerationDate": "03/22/2011",
"LastUpdateDate": "03/22/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LI",
"AuthorizedOfficialFirstName": "DENA",
"AuthorizedOfficialMiddleName": "Y",
"AuthorizedOfficialTitle": "MD",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "732-603-0055",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "MA69929",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}