{
"Npi": {
"NPI": "1477579332",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ACTIVE SPORTS MEDICINE & ORTHOPAEDIC SURGERY 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": "757 LINCOLN BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LONG BEACH",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11561-2355",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-432-8800",
"MailingAddressFaxNumber": "516-432-8801",
"FirstLinePracticeLocationAddress": "757 LINCOLN BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LONG BEACH",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11561-2355",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-432-8800",
"PracticeLocationAddressFaxNumber": "516-432-8801",
"EnumerationDate": "07/14/2006",
"LastUpdateDate": "02/28/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "UH",
"AuthorizedOfficialFirstName": "BENJAMIN",
"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OFFICER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "516-432-8800",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207X00000X",
"TaxonomyName": "Orthopaedic Surgery Physician",
"LicenseNumber": "201193",
"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."
}
}
}
}