{
"Npi": {
"NPI": "1134590383",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ALBERT N BONANNO DDS 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": "2631 MERRICK RD",
"SecondLineMailingAddress": "404",
"MailingAddressCityName": "BELLMORE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11710-5730",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-658-3885",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2631 MERRICK RD",
"SecondLinePracticeLocationAddress": "404",
"PracticeLocationAddressCityName": "BELLMORE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11710-5730",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-658-3885",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/14/2015",
"LastUpdateDate": "10/14/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BONANNO",
"AuthorizedOfficialFirstName": "ALBERT",
"AuthorizedOfficialMiddleName": "NOEL",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "917-209-4730",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "335E00000X",
"TaxonomyName": "Prosthetic/Orthotic Supplier",
"LicenseNumber": "032364",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}