{
"Npi": {
"NPI": "1891130795",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "EATING DISORDER TREATMENT OF NEW YORK, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "6100 SW 76TH STREET",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOUTH MIAMI",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33143",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "305-663-1876",
"MailingAddressFaxNumber": "914-479-5490",
"FirstLinePracticeLocationAddress": "437 5TH AVE FL 8",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10016-2205",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "646-833-7325",
"PracticeLocationAddressFaxNumber": "646-833-7322",
"EnumerationDate": "05/06/2013",
"LastUpdateDate": "06/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHULZ",
"AuthorizedOfficialFirstName": "JASON",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CHIEF FINANCIAL OFFICER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "720-440-4277",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "8161001A",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}