{
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"NamePrefix": null,
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"FirstLineMailingAddress": "1000 MONTAUK HWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST ISLIP",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11795-4927",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-376-4003",
"MailingAddressFaxNumber": "631-224-8560",
"FirstLinePracticeLocationAddress": "1000 MONTAUK HWY",
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"PracticeLocationAddressCityName": "WEST ISLIP",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-376-4003",
"PracticeLocationAddressFaxNumber": "631-224-8560",
"EnumerationDate": "12/29/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HANNIGAN",
"AuthorizedOfficialFirstName": "DAVE",
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"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "631-224-8533",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}