{
"Npi": {
"NPI": "1780077263",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "AFOLABI",
"FirstName": "JIMOH",
"MiddleName": "DAVID",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "LPN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "74 CAROLINE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELMONT",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11003-5019",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-395-3674",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "74 CAROLINE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ELMONT",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11003-5019",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-395-3674",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/09/2015",
"LastUpdateDate": "03/09/2015",
"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": "164W00000X",
"TaxonomyName": "Licensed Practical Nurse",
"LicenseNumber": "321500",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "164W00000X",
"TaxonomyName": "Licensed Practical Nurse",
"LicenseNumber": "26NP07227600",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}