{
"Npi": {
"NPI": "1760521959",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MODERN MEDICAL PRACTICE PLLC",
"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 110",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HASTINGS ON HUDSON",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10706-0110",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "914-478-5121",
"MailingAddressFaxNumber": "866-862-1608",
"FirstLinePracticeLocationAddress": "30 MAIN ST FL 1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HASTINGS ON HUDSON",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10706-1602",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "914-478-5121",
"PracticeLocationAddressFaxNumber": "866-862-1608",
"EnumerationDate": "02/05/2007",
"LastUpdateDate": "10/17/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POPESCU",
"AuthorizedOfficialFirstName": "OXANA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "917-627-7591",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "238747 1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}