{
"Npi": {
"NPI": "1972664449",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FITZPATRICK",
"FirstName": "EDWARD",
"MiddleName": "TED",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DPM",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "425 ESSJAY RD STE 170",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WILLIAMSVILLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14221-8235",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-630-1219",
"MailingAddressFaxNumber": "716-817-1726",
"FirstLinePracticeLocationAddress": "6325 MAIN ST",
"SecondLinePracticeLocationAddress": "SUITE 200",
"PracticeLocationAddressCityName": "WILLIAMSVILLE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14221-5822",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-839-3930",
"PracticeLocationAddressFaxNumber": "716-839-2667",
"EnumerationDate": "12/12/2006",
"LastUpdateDate": "06/21/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "0103300945",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "1144",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "213ES0103X",
"TaxonomyName": "Foot & Ankle Surgery Podiatrist",
"LicenseNumber": "N006292",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}