{
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"OrgName": "NY PHYSICAL THERAPY & WELLNESS, MELVILLE, PLLC",
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"FirstLineMailingAddress": "1800 WALT WHITMAN RD STE 120",
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"MailingAddressCityName": "MELVILLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11747-3237",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-694-0005",
"MailingAddressFaxNumber": "631-694-0007",
"FirstLinePracticeLocationAddress": "535 BROADHOLLOW RD",
"SecondLinePracticeLocationAddress": "SUITE A10",
"PracticeLocationAddressCityName": "MELVILLE",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-694-0005",
"PracticeLocationAddressFaxNumber": "631-694-0007",
"EnumerationDate": "09/13/2006",
"LastUpdateDate": "03/05/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BREDOW",
"AuthorizedOfficialFirstName": "RONALD",
"AuthorizedOfficialMiddleName": "J",
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"AuthorizedOfficialNamePrefix": "MR.",
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"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "631-694-0005",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "021022-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}