{
"Npi": {
"NPI": "1861748444",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "COMPLETE VASCULAR INC",
"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": "25 ROCKWOOD PL",
"SecondLineMailingAddress": "SUITE #425",
"MailingAddressCityName": "ENGLEWOOD",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07631-4957",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "201-569-1101",
"MailingAddressFaxNumber": "201-567-4039",
"FirstLinePracticeLocationAddress": "25 ROCKWOOD PL",
"SecondLinePracticeLocationAddress": "SUITE #425",
"PracticeLocationAddressCityName": "ENGLEWOOD",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "07631-4957",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "201-569-1101",
"PracticeLocationAddressFaxNumber": "201-567-4039",
"EnumerationDate": "08/01/2012",
"LastUpdateDate": "08/01/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "IMPEDUGLIA",
"AuthorizedOfficialFirstName": "THERESA",
"AuthorizedOfficialMiddleName": "MARIA",
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "201-658-5882",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2086S0129X",
"TaxonomyName": "Vascular Surgery Physician",
"LicenseNumber": "25MA07266800",
"LicenseNumberStateCode": "NJ",
"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."
}
}
}
}