{
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"OrgName": "OMNICARE ANESTHESIA",
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"NamePrefix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 30036",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ELMONT",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11003-0036",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-369-3080",
"MailingAddressFaxNumber": "718-369-3271",
"FirstLinePracticeLocationAddress": "55 GREENE AVE",
"SecondLinePracticeLocationAddress": "STE: LLA",
"PracticeLocationAddressCityName": "BROOKLYN",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressTelephoneNumber": "718-622-0111",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/08/2007",
"LastUpdateDate": "08/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CREVECOEUR",
"AuthorizedOfficialFirstName": "EVANS",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "718-986-0593",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}