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1194863134 NPI number — LEONARD THOMAS FAZIO D.D.S., P.C.

NPI Number: 1194863134
Health Care Provider/Practitioner: LEONARD THOMAS FAZIO D.D.S., P.C.

Information about “1194863134” NPI (LEONARD THOMAS FAZIO D.D.S., P.C.) exists in 1194863134 in HTML format HTML  |  1194863134 in plain Text format TXT  |  1194863134 in PDF (Portable Document Format) PDF  |  1194863134 in an XML format XML  formats.

NPI Number : 1194863134 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194863134",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FAZIO",
    "FirstName": "LEONARD",
    "MiddleName": "THOMAS",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.D.S., P.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1303 MAIN ST",
    "SecondLineMailingAddress": "THE PEN AND PENCIL BUILDING SUITE 2",
    "MailingAddressCityName": "PORT JEFFERSON",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11777-2257",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-474-7477",
    "MailingAddressFaxNumber": "631-474-7427",
    "FirstLinePracticeLocationAddress": "1303 MAIN ST",
    "SecondLinePracticeLocationAddress": "THE PEN AND PENCIL BUILDING SUITE 2",
    "PracticeLocationAddressCityName": "PORT JEFFERSON",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11777-2257",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-474-7477",
    "PracticeLocationAddressFaxNumber": "631-474-7427",
    "EnumerationDate": "02/02/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "1223G0001X",
        "TaxonomyName": "General Practice Dentistry",
        "LicenseNumber": "041861",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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