{
"Npi": {
"NPI": "1992938096",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FEDORCZYK",
"FirstName": "MARYJANE",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PT. PHD, CHT, ATC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FEDORCZYK",
"OtherFirstName": "JANE",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PT. PHD, CHT, ATC",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "245 N 15TH ST",
"SecondLineMailingAddress": "MAIL STOP 502",
"MailingAddressCityName": "PHILADELPHIA",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19102-1101",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "215-762-4680",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "245 N 15TH ST",
"SecondLinePracticeLocationAddress": "MAIL STOP 502",
"PracticeLocationAddressCityName": "PHILADELPHIA",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19102-1101",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "215-762-4680",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/24/2009",
"LastUpdateDate": "08/24/2009",
"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": "2251H1200X",
"TaxonomyName": "Hand Physical Therapist",
"LicenseNumber": "PT006083L",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "2251H1200X",
"TaxonomyName": "Hand Physical Therapist",
"LicenseNumber": "40QA00546800",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}