{
"Npi": {
"NPI": "1255280467",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "SUFFOLK NURSE PRACTITIONER IN FAMILY HEALTH PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "140 N BELLE MEAD AVE STE G",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "EAST SETAUKET",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11733-6400",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-689-8662",
"MailingAddressFaxNumber": "631-706-2221",
"FirstLinePracticeLocationAddress": "140 N BELLE MEAD AVE STE G",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EAST SETAUKET",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11733-6400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-689-8662",
"PracticeLocationAddressFaxNumber": "631-706-2221",
"EnumerationDate": "01/22/2026",
"LastUpdateDate": "02/02/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SMITH",
"AuthorizedOfficialFirstName": "DOREEN",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "631-523-7826",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}