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1992455398 NPI number — JUSTIN MICHAEL TAYLOR I LICENSED MSW

NPI Number: 1992455398
Health Care Provider/Practitioner: JUSTIN MICHAEL TAYLOR I LICENSED MSW

Information about “1992455398” NPI (JUSTIN MICHAEL TAYLOR I LICENSED MSW) exists in 1992455398 in HTML format HTML  |  1992455398 in plain Text format TXT  |  1992455398 in PDF (Portable Document Format) PDF  |  1992455398 in an XML format XML  formats.

NPI Number : 1992455398 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992455398",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TAYLOR",
    "FirstName": "JUSTIN",
    "MiddleName": "MICHAEL",
    "NamePrefix": null,
    "NameSuffix": "I",
    "Credential": "LICENSED MSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "153 LAKE SHORE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAKE RONKONKOMA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11779-3193",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-471-5666",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "153 LAKE SHORE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAKE RONKONKOMA",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11779-3193",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-471-5666",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/28/2022",
    "LastUpdateDate": "01/02/2026",
    "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": "104100000X",
        "TaxonomyName": "Social Worker",
        "LicenseNumber": "104733-01",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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