{
"Npi": {
"NPI": "1083996227",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "VINCENT ANZALONE PHYSICIAN 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,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "700 HICKSVILLE RD",
"SecondLineMailingAddress": "SUITE 200B",
"MailingAddressCityName": "BETHPAGE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11714-3471",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-576-5651",
"MailingAddressFaxNumber": "516-576-5820",
"FirstLinePracticeLocationAddress": "847 N BROADWAY",
"SecondLinePracticeLocationAddress": "SUITE 103",
"PracticeLocationAddressCityName": "MASSAPEQUA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11758-2373",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-798-0441",
"PracticeLocationAddressFaxNumber": "516-798-0445",
"EnumerationDate": "09/14/2011",
"LastUpdateDate": "09/14/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANZALONE",
"AuthorizedOfficialFirstName": "VINCENT",
"AuthorizedOfficialMiddleName": "PETER",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "516-798-0441",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "157952",
"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."
}
}
}
}