{
"Npi": {
"NPI": "1770688277",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VAN EYCK",
"FirstName": "CHRISTOPHER",
"MiddleName": "ROBERT",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3123 NORTHWOOD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRFAX",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22031-1014",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-828-4383",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "239 GARRISONVILLE RD STE 201",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STAFFORD",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22554-1554",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-373-7338",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/13/2006",
"LastUpdateDate": "09/21/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": "0110004052",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": "1749",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}