{
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"IsOrgSubpart": "N",
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"OrgName": "MANOMEDNET INC.",
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"NamePrefix": null,
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"FirstLineMailingAddress": "379 SILVER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WILBRAHAM",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01095-9811",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "413-544-8998",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "40 WRIGHT ST",
"SecondLinePracticeLocationAddress": "WING BAYSTATE RADIOLOGY",
"PracticeLocationAddressCityName": "PALMER",
"PracticeLocationAddressStateName": "MA",
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"PracticeLocationAddressTelephoneNumber": "413-284-5243",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/19/2014",
"LastUpdateDate": "12/22/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALLARD",
"AuthorizedOfficialFirstName": "JEFFREY",
"AuthorizedOfficialMiddleName": "C",
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"AuthorizedOfficialCredential": "M.D.",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2085R0202X",
"TaxonomyName": "Diagnostic Radiology Physician",
"LicenseNumber": "42902",
"LicenseNumberStateCode": "MA",
"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."
}
}
}
}