{
"Npi": {
"NPI": "1558756247",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOHNEY",
"FirstName": "DESIREE",
"MiddleName": "NICOLE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WAGNER",
"OtherFirstName": "DESIREE",
"OtherMiddleName": "NICOLE",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "601 ELMWOOD AVE BOX 635",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROCHESTER",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14642-0001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "585-276-4113",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "601 ELMWOOD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROCHESTER",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14642-0001",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "585-276-4113",
"PracticeLocationAddressFaxNumber": "570-808-6072",
"EnumerationDate": "03/31/2015",
"LastUpdateDate": "07/22/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208M00000X",
"TaxonomyName": "Hospitalist Physician",
"LicenseNumber": "MD463914",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "317188",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208000000X",
"TaxonomyName": "Pediatrics Physician",
"LicenseNumber": "317188",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}