{
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"EIN": null,
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"OrgName": "REISFELD, SORIA, GUTTERSON & SHERIDAN DENTAL SERVICES, PLLC",
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"NameSuffix": null,
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"FirstLineMailingAddress": "335 TERRY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SMITHTOWN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11787-5510",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-724-0104",
"MailingAddressFaxNumber": "631-724-2861",
"FirstLinePracticeLocationAddress": "335 TERRY RD",
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"PracticeLocationAddressCityName": "SMITHTOWN",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "631-724-2861",
"EnumerationDate": "03/17/2009",
"LastUpdateDate": "03/17/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REISFELD",
"AuthorizedOfficialFirstName": "STACY",
"AuthorizedOfficialMiddleName": "H",
"AuthorizedOfficialTitle": "MANAGING MEMBER",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "D.D.S.",
"AuthorizedOfficialTelephoneNumber": "631-724-0104",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "041693-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}