{
"Npi": {
"NPI": "1811789753",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "TEAMMD AT MILLBURN LLC",
"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": "14 CLIFFWOOD AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MATAWAN",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07747-3908",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "973-912-8111",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "37 E WILLOW ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MILLBURN",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07041-1416",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "973-821-3387",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/19/2025",
"LastUpdateDate": "10/22/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUFANO",
"AuthorizedOfficialFirstName": "NICK",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGING PARTNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "973-912-8111",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QA1903X",
"TaxonomyName": "Ambulatory Surgical Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}