{
"Npi": {
"NPI": "1215335823",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NURSING SERVICE PROVIDER",
"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": "916 SPUR DR S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BAY SHORE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11706-4709",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-647-3048",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "916 SPUR DR S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BAY SHORE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11706-4709",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-647-3048",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/12/2014",
"LastUpdateDate": "12/12/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PHILOGENE",
"AuthorizedOfficialFirstName": "EMMANUEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "LPN",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "631-647-3048",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": "312239-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}