{
"Npi": {
"NPI": "1093891277",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SMIRNOV",
"FirstName": "VIKTOR",
"MiddleName": "B",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "30 MERRICK AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAST MEADOW",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11554",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-794-0444",
"MailingAddressFaxNumber": "516-542-0414",
"FirstLinePracticeLocationAddress": "300 OLD COUNTRY RD STE 101",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MINEOLA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11501-4112",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-741-4138",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/31/2006",
"LastUpdateDate": "05/03/2023",
"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": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "15973",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "2086S0129X",
"TaxonomyName": "Vascular Surgery Physician",
"LicenseNumber": "15973-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}