{
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"IsOrgSubpart": "N",
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"OrgName": "SRIVIDHYA SUBBARAYAN M D PROFESSIONAL ASSOCIATION",
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"FirstLineMailingAddress": "78 HARDING AVE",
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"MailingAddressCityName": "EDISON",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "08820-2524",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "347-834-2592",
"MailingAddressFaxNumber": "732-791-2761",
"FirstLinePracticeLocationAddress": "666 PLAINSBORO RD",
"SecondLinePracticeLocationAddress": "SUITE 2000 B",
"PracticeLocationAddressCityName": "PLAINSBORO",
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"PracticeLocationAddressPostalCode": "08536-3030",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "609-799-1100",
"PracticeLocationAddressFaxNumber": "609-799-1189",
"EnumerationDate": "04/25/2007",
"LastUpdateDate": "08/06/2007",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SUBBARAYAN",
"AuthorizedOfficialFirstName": "SRIVIDHYA",
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"AuthorizedOfficialTitle": "DIRECTOR",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "347-834-2592",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "25MA07067800",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}