{
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BERRY ORTHOPEDIC INC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 540596",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OPA LOCKA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33054-0596",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-651-3040",
"MailingAddressFaxNumber": "305-651-3237",
"FirstLinePracticeLocationAddress": "1875 NE 163RD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH MIAMI BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33162",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-651-3040",
"PracticeLocationAddressFaxNumber": "305-651-3237",
"EnumerationDate": "11/07/2007",
"LastUpdateDate": "08/29/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BERRY",
"AuthorizedOfficialFirstName": "RAYMOND",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT/ OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "L.P.O. C.P.O.",
"AuthorizedOfficialTelephoneNumber": "305-651-3040",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "POR 107",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "335E00000X",
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"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}