{
"Npi": {
"NPI": "1801795471",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MADISON MEDICAL DIAGNOSTICS & SPORTS REHAB CENTTER",
"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": "345 MAIN ST STE 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MADISON",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07940-2384",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-377-6700",
"MailingAddressFaxNumber": "973-377-8008",
"FirstLinePracticeLocationAddress": "345 MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MADISON",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07940-2383",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-377-6700",
"PracticeLocationAddressFaxNumber": "973-377-8008",
"EnumerationDate": "11/02/2026",
"LastUpdateDate": "11/02/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OLIVEIRA",
"AuthorizedOfficialFirstName": "RENEE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "COO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "917-242-1517",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0401X",
"TaxonomyName": "Comprehensive Outpatient Rehabilitation Facility (CORF)",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}