{
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"IsOrgSubpart": "N",
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"OrgName": "COMMUNITY CARE PHYSICAL THERAPY P.C.",
"LastName": null,
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"FirstLineMailingAddress": "8510 122ND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KEW GARDENS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11415-3232",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-501-0421",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8510 122ND ST",
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"PracticeLocationAddressCityName": "KEW GARDENS",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressTelephoneNumber": "718-501-0421",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/10/2013",
"LastUpdateDate": "06/10/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JAIN",
"AuthorizedOfficialFirstName": "VIRENDER",
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"AuthorizedOfficialTitle": "MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "917-715-7671",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapist",
"LicenseNumber": "031350-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}