{
"Npi": {
"NPI": "1003161571",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LONG ISLAND ALLERGY AND ASTHMA 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": "2500 NESCONSET HWY BLDG 17A",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STONY BROOK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11790-2563",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-751-6262",
"MailingAddressFaxNumber": "631-751-6268",
"FirstLinePracticeLocationAddress": "2500 NESCONSET HWY BLDG 17A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "STONY BROOK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11790-2563",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-751-6262",
"PracticeLocationAddressFaxNumber": "631-751-6268",
"EnumerationDate": "07/19/2012",
"LastUpdateDate": "10/05/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CYMERMAN",
"AuthorizedOfficialFirstName": "DIANE",
"AuthorizedOfficialMiddleName": "H",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "631-751-6262",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207K00000X",
"TaxonomyName": "Allergy & Immunology Physician",
"LicenseNumber": "161005",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}