{
"Npi": {
"NPI": "1265520399",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MERRICK ORAL SURGERY PLLC",
"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": "2116 MERRICK AVE SUITE 4008.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MERRICK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11566",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-546-1444",
"MailingAddressFaxNumber": "516-546-5576",
"FirstLinePracticeLocationAddress": "2116 MERRICK AVE",
"SecondLinePracticeLocationAddress": "SUITE 4008",
"PracticeLocationAddressCityName": "MERRICK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11566",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-546-1444",
"PracticeLocationAddressFaxNumber": "516-546-5576",
"EnumerationDate": "10/11/2006",
"LastUpdateDate": "12/08/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DABUNDO",
"AuthorizedOfficialFirstName": "STEVEN",
"AuthorizedOfficialMiddleName": "M",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "516-546-1444",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "204E00000X",
"TaxonomyName": "Oral & Maxillofacial Surgery (D.M.D.)",
"LicenseNumber": null,
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223P0106X",
"TaxonomyName": "Oral and Maxillofacial Pathology Dentistry",
"LicenseNumber": null,
"LicenseNumberStateCode": "NY",
"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."
},
{
"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."
}
]
}
}
}