{
"Npi": {
"NPI": "1861876328",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "CHRISTAL D CHARBONNET, DPM P.C.",
"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": "PO BOX 15616",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW ORLEANS",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70175-5616",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "504-460-0987",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4243 RICHMOND AVE",
"SecondLinePracticeLocationAddress": "1ST FLOOR",
"PracticeLocationAddressCityName": "STATEN ISLAND",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10312-6221",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "504-460-0987",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/15/2015",
"LastUpdateDate": "07/15/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHARBONNET",
"AuthorizedOfficialFirstName": "CHRISTAL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PROVIDER/OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "504-460-0987",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0131X",
"TaxonomyName": "Foot Surgery Podiatrist",
"LicenseNumber": "N006465",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}