{
"Npi": {
"NPI": "1902980691",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "IPPOLITO-FATA",
"FirstName": "JUSTINE",
"MiddleName": "PAULA",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "IPPOLITO",
"OtherFirstName": "JUSTINE",
"OtherMiddleName": "P",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "DDS",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "125 WALKER ST FL 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10013-4135",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-226-8866",
"MailingAddressFaxNumber": "212-226-2289",
"FirstLinePracticeLocationAddress": "131-72 40TH ROAD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLUSHING",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11354",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-587-1111",
"PracticeLocationAddressFaxNumber": "718-886-3903",
"EnumerationDate": "10/25/2006",
"LastUpdateDate": "07/02/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "043215",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}