{
"Npi": {
"NPI": "1821441635",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PROFESSIONAL PODIATRY 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": "43 STONERIDGE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THORNTON",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19373-1042",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "610-357-6303",
"MailingAddressFaxNumber": "484-730-0060",
"FirstLinePracticeLocationAddress": "500 ORCHARD AVE",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "KENNETT SQUARE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19348-1812",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "610-388-8637",
"PracticeLocationAddressFaxNumber": "484-730-0060",
"EnumerationDate": "07/16/2016",
"LastUpdateDate": "02/06/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KUTVOELGYI",
"AuthorizedOfficialFirstName": "ERIN",
"AuthorizedOfficialMiddleName": "ELIZABETH",
"AuthorizedOfficialTitle": "PODIATRIST/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "610-357-6303",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0131X",
"TaxonomyName": "Foot Surgery Podiatrist",
"LicenseNumber": "SC005540",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}