{
"Npi": {
"NPI": "1851479570",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COTTRELL",
"FirstName": "ERIC",
"MiddleName": "KENNETH",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "36 HOMER AVENUE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "QUEENSBURY",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12804-2009",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-793-1345",
"MailingAddressFaxNumber": "518-793-9347",
"FirstLinePracticeLocationAddress": "36 HOMER AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "QUEENSBURY",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12804-2009",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-793-1345",
"PracticeLocationAddressFaxNumber": "518-793-9347",
"EnumerationDate": "11/01/2006",
"LastUpdateDate": "07/08/2007",
"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": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "45226",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}