{
"Npi": {
"NPI": "1497659098",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "ANCHOR NP IN PSYCHIATRY SERVICES PLLC",
"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": "68 S SERVICE RD STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MELVILLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11747-2350",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-316-4689",
"MailingAddressFaxNumber": "925-281-2589",
"FirstLinePracticeLocationAddress": "68 S SERVICE RD STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MELVILLE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11747-2350",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-316-4689",
"PracticeLocationAddressFaxNumber": "925-281-2589",
"EnumerationDate": "10/06/2026",
"LastUpdateDate": "10/06/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KHURSAND",
"AuthorizedOfficialFirstName": "AVESTA",
"AuthorizedOfficialMiddleName": "MIRIAM",
"AuthorizedOfficialTitle": "PROVIDER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "516-316-4689",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": "NULL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}