{
"Npi": {
"NPI": "1801070172",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MEDFORD HAMLET, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1529 N OCEAN AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MEDFORD",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11763-3556",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-289-0622",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1529 N OCEAN AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MEDFORD",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11763-3556",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-289-0622",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/21/2007",
"LastUpdateDate": "12/21/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BENENSON",
"AuthorizedOfficialFirstName": "MICHAEL",
"AuthorizedOfficialMiddleName": "J",
"AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "631-289-0600",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "310400000X",
"TaxonomyName": "Assisted Living Facility",
"LicenseNumber": "700-F-921",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}