{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "MARYANN RUSSO, PT",
"LastName": null,
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"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "3535 HILL BLVD",
"SecondLineMailingAddress": "SUITE P",
"MailingAddressCityName": "YORKTOWN HEIGHTS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10598-1293",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "914-962-2728",
"MailingAddressFaxNumber": "914-962-1729",
"FirstLinePracticeLocationAddress": "3535 HILL BLVD",
"SecondLinePracticeLocationAddress": "SUITE P",
"PracticeLocationAddressCityName": "YORKTOWN HEIGHTS",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10598-1293",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "914-962-2728",
"PracticeLocationAddressFaxNumber": "914-962-1729",
"EnumerationDate": "05/29/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RUSSO",
"AuthorizedOfficialFirstName": "MARYANN",
"AuthorizedOfficialMiddleName": "C",
"AuthorizedOfficialTitle": "DIRECTOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.S., P.T.",
"AuthorizedOfficialTelephoneNumber": "914-962-2728",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}