{
"Npi": {
"NPI": "1497023964",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NORTH SHORE TMS LLC",
"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": "75 PROSPECT ST STE 105",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HUNTINGTON",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11743-3310",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-923-0006",
"MailingAddressFaxNumber": "631-498-0189",
"FirstLinePracticeLocationAddress": "75 PROSPECT ST STE 102",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HUNTINGTON",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11743-3320",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-923-0006",
"PracticeLocationAddressFaxNumber": "631-498-0189",
"EnumerationDate": "12/12/2011",
"LastUpdateDate": "10/12/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARLSEN",
"AuthorizedOfficialFirstName": "ANDREA",
"AuthorizedOfficialMiddleName": "R.",
"AuthorizedOfficialTitle": "MEDICAL DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "631-923-0006",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "242634",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}