{
"Npi": {
"NPI": "1922345271",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ACOSTA PHYSICAL THERAPY PC",
"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": "219-32 64TH AVENUE",
"SecondLineMailingAddress": "3RD FLOOR",
"MailingAddressCityName": "OAKLAND GARDENS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11364",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-312-0082",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6134 188TH ST",
"SecondLinePracticeLocationAddress": "SUITE 208",
"PracticeLocationAddressCityName": "FRESH MEADOWS",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11365-2719",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-264-1979",
"PracticeLocationAddressFaxNumber": "718-254-3020",
"EnumerationDate": "01/07/2013",
"LastUpdateDate": "09/05/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ACOSTA",
"AuthorizedOfficialFirstName": "ALVARO",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPT",
"AuthorizedOfficialTelephoneNumber": "516-312-0082",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "028426-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}