{
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"IsOrgSubpart": "N",
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"OrgName": "LSA SURGERY & CONSULTATION PC",
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"FirstLineMailingAddress": "145 PROSPECT ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIDGEWOOD",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07450-4493",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "201-444-4412",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "145 PROSPECT ST",
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"PracticeLocationAddressCityName": "RIDGEWOOD",
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"PracticeLocationAddressTelephoneNumber": "201-444-4412",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/26/2012",
"LastUpdateDate": "11/26/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARNEVALE",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "201-444-4412",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "25MA02025300",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}