{
"Npi": {
"NPI": "1457772931",
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ALBANY UPSTATE DENTAL 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": "540 BROADWAY",
"SecondLineMailingAddress": "100",
"MailingAddressCityName": "ALBANY",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12207-2708",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-465-0808",
"MailingAddressFaxNumber": "518-465-1450",
"FirstLinePracticeLocationAddress": "540 BROADWAY",
"SecondLinePracticeLocationAddress": "100",
"PracticeLocationAddressCityName": "ALBANY",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12207-2708",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-465-0808",
"PracticeLocationAddressFaxNumber": "518-465-1450",
"EnumerationDate": "12/30/2013",
"LastUpdateDate": "12/30/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MALIK",
"AuthorizedOfficialFirstName": "TARIQ",
"AuthorizedOfficialMiddleName": "PASHA",
"AuthorizedOfficialTitle": "OWNER / DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "518-465-0808",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "050817",
"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."
}
}
}
}