{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "YURIY NEKTALOV, DDS, PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherLastName": null,
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"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9424 63RD DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "REGO PARK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11374-2028",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-997-7762",
"MailingAddressFaxNumber": "718-897-9060",
"FirstLinePracticeLocationAddress": "9424 63RD DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "REGO PARK",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-997-7762",
"PracticeLocationAddressFaxNumber": "718-897-9060",
"EnumerationDate": "11/03/2008",
"LastUpdateDate": "11/03/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NEKTALOV",
"AuthorizedOfficialFirstName": "YURIY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DENTIST",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "718-997-7762",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "047891",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
}
}
}