{
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"OrgName": "NEW YORK ORTHODONTIC GROUP DBA JACKSON HEIGHTS ORTHODONTICS",
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"FirstLineMailingAddress": "7409 37TH AVE",
"SecondLineMailingAddress": "SUITE 301",
"MailingAddressCityName": "JACKSON HEIGHTS",
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"MailingAddressPostalCode": "11372",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-335-4444",
"MailingAddressFaxNumber": "718-335-1855",
"FirstLinePracticeLocationAddress": "7409 37TH AVE",
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"PracticeLocationAddressCityName": "JACKSON HEIGHTS",
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"PracticeLocationAddressFaxNumber": "718-335-1855",
"EnumerationDate": "09/27/2012",
"LastUpdateDate": "09/27/2012",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GIANNOUTSOS",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223X0400X",
"TaxonomyName": "Orthodontics and Dentofacial Orthopedics Dentistry",
"LicenseNumber": "NY052416",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}