{
"Npi": {
"NPI": "1467943522",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC",
"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": "1500 ROUTE 112 STE 101",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORT JEFFERSON STATION",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11776-8054",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-751-3000",
"MailingAddressFaxNumber": "631-509-6559",
"FirstLinePracticeLocationAddress": "750 OLD COUNTRY RD BLDG 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIVERHEAD",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11901",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-751-3000",
"PracticeLocationAddressFaxNumber": "631-509-6559",
"EnumerationDate": "05/24/2018",
"LastUpdateDate": "01/31/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DANDRAIA",
"AuthorizedOfficialFirstName": "PATRICIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CREDENTIALING COORDINATOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CREDENTIALING",
"AuthorizedOfficialTelephoneNumber": "631-751-3000",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QX0203X",
"TaxonomyName": "Radiation Oncology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QR0200X",
"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207RH0003X",
"TaxonomyName": "Hematology & Oncology Physician",
"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."
}
}
}
}