{
"Npi": {
"NPI": "1902355423",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PREFERRED FOOT AND ANKLE CENTER PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4 ROSE AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FEASTERVILLE TREVOSE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19053-4324",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-355-7555",
"MailingAddressFaxNumber": "267-352-4032",
"FirstLinePracticeLocationAddress": "4 ROSE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FEASTERVILLE TREVOSE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19053-4324",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-355-7555",
"PracticeLocationAddressFaxNumber": "267-352-4032",
"EnumerationDate": "09/26/2016",
"LastUpdateDate": "03/03/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TYSHKO",
"AuthorizedOfficialFirstName": "ELZA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PODIATRIST",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "215-355-7555",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "SC006504",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}