{
"Npi": {
"NPI": "1043441777",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BODIAN MEDICAL SERVICES OF FOREST HILLS 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": "11 GRACE AVE",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "GREAT NECK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11021-2417",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-482-2882",
"MailingAddressFaxNumber": "516-482-6039",
"FirstLinePracticeLocationAddress": "10420 QUEENS BLVD",
"SecondLinePracticeLocationAddress": "SUITE 1D",
"PracticeLocationAddressCityName": "FOREST HILLS",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11375-3629",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-459-2121",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/29/2009",
"LastUpdateDate": "07/29/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BODIAN",
"AuthorizedOfficialFirstName": "ADAM",
"AuthorizedOfficialMiddleName": "B.",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "516-482-2882",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "176289",
"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."
}
}
}
}