{
"Npi": {
"NPI": "1619637402",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "AGNEW",
"FirstName": "GREGORY",
"MiddleName": "WILLIAM",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "L.AC, LMT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "22 LINCOLN PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLEN COVE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11542-1949",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-857-3723",
"MailingAddressFaxNumber": "516-674-9031",
"FirstLinePracticeLocationAddress": "63 AUDREY AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OYSTER BAY",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11771-1503",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-857-3723",
"PracticeLocationAddressFaxNumber": "516-674-9031",
"EnumerationDate": "12/21/2021",
"LastUpdateDate": "11/09/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "019277",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "007033",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}