{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "GABRIEL F. DEANGELIS MD PC",
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"FirstLineMailingAddress": "16215 HIGHLAND AVE",
"SecondLineMailingAddress": "1F",
"MailingAddressCityName": "JAMAICA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11432-3452",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-657-8171",
"MailingAddressFaxNumber": "718-657-0548",
"FirstLinePracticeLocationAddress": "16215 HIGHLAND AVE",
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"PracticeLocationAddressTelephoneNumber": "718-657-8171",
"PracticeLocationAddressFaxNumber": "718-657-0548",
"EnumerationDate": "07/13/2008",
"LastUpdateDate": "09/09/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DEANGELIS",
"AuthorizedOfficialFirstName": "GABRIEL",
"AuthorizedOfficialMiddleName": "FRANCIS",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "718-657-8171",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "099931",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}