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1770054710 NPI number — HEIDI FYRBERG PHYSICIAN ASSISTANT PC

NPI Number: 1770054710
Health Care Provider/Practitioner: HEIDI FYRBERG PHYSICIAN ASSISTANT PC

Information about “1770054710” NPI (HEIDI FYRBERG PHYSICIAN ASSISTANT PC) exists in 1770054710 in HTML format HTML  |  1770054710 in plain Text format TXT  |  1770054710 in PDF (Portable Document Format) PDF  |  1770054710 in an XML format XML  formats.

NPI Number : 1770054710 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770054710",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "HEIDI FYRBERG PHYSICIAN ASSISTANT PC",
    "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": "20 DONOVAN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLD SPRING HARBOR",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11724-2222",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "516-652-7100",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1895 WALT WHITMAN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MELVILLE",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11747-3031",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-652-7100",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/17/2018",
    "LastUpdateDate": "12/17/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FYRBERG-COHEN",
    "AuthorizedOfficialFirstName": "HEIDI",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PHYSICIAN ASSISTANT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PA",
    "AuthorizedOfficialTelephoneNumber": "516-652-7100",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363AS0400X",
        "TaxonomyName": "Surgical Physician Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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