{
"Npi": {
"NPI": "1194284893",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MENS HEALTH OF SMITHTOWN",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "329 E MIDDLE COUNTRY RD STE 8",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SMITHTOWN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11787-2821",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-343-7880",
"MailingAddressFaxNumber": "631-343-7881",
"FirstLinePracticeLocationAddress": "329 E MIDDLE COUNTRY RD STE 8",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SMITHTOWN",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11787-2821",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-343-7880",
"PracticeLocationAddressFaxNumber": "631-343-7710",
"EnumerationDate": "03/13/2019",
"LastUpdateDate": "09/07/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KAUFMAN",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": "MICHAEL",
"AuthorizedOfficialTitle": "PRESADENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "ETC",
"AuthorizedOfficialTelephoneNumber": "631-343-7880",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0002X",
"TaxonomyName": "Clinic Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}