{
"Npi": {
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "GREGORY P. COLLIS",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "212 HIGHLAND ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SYRACUSE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13203-1603",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "315-382-6725",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8196 GREEN RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HUBBARDSVILLE",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "315-382-6725",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "05/24/2007",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "COLLIS",
"AuthorizedOfficialFirstName": "GREGORY",
"AuthorizedOfficialMiddleName": "PAUL",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "315-382-6725",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "343900000X",
"TaxonomyName": "Non-emergency Medical Transport (VAN)",
"LicenseNumber": "02056302",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}