{
"Npi": {
"NPI": "1255479119",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTH SHORE PHYSICAL MEDICINE AND REHABILITATION SERVICES, 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": "PO BOX 1357",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BAYVILLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11709-0357",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-794-4161",
"MailingAddressFaxNumber": "516-794-9568",
"FirstLinePracticeLocationAddress": "4 EXPRESSWAY PLZ",
"SecondLinePracticeLocationAddress": "STE 110",
"PracticeLocationAddressCityName": "ROSLYN HEIGHTS",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11577-2059",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-621-4062",
"PracticeLocationAddressFaxNumber": "516-621-1848",
"EnumerationDate": "02/02/2007",
"LastUpdateDate": "11/06/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROOT",
"AuthorizedOfficialFirstName": "BARRY",
"AuthorizedOfficialMiddleName": "C.",
"AuthorizedOfficialTitle": "OWNER PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "516-621-4062",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225400000X",
"TaxonomyName": "Rehabilitation Practitioner",
"LicenseNumber": "167868-1",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}