{
"Npi": {
"NPI": "1588832984",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NANETTE D PHILLIS, MD, PLLC",
"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": "2365 S CLINTON AVE",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "ROCHESTER",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14618-2663",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "585-461-9500",
"MailingAddressFaxNumber": "585-271-1432",
"FirstLinePracticeLocationAddress": "2365 S CLINTON AVE",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "ROCHESTER",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14618-2663",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "585-461-9500",
"PracticeLocationAddressFaxNumber": "585-271-1432",
"EnumerationDate": "02/19/2008",
"LastUpdateDate": "02/19/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "OPHARDT",
"AuthorizedOfficialFirstName": "ANDREW",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "BUSINESS MANAGER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "585-755-7878",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "195745",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}