{
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"EIN": null,
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"OrgName": "DR. SIMON KOYFMAN, PHYSICIAN, P.L.L.C.",
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"FirstLineMailingAddress": "170 AVENUE S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKLYN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11223-2633",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-382-8282",
"MailingAddressFaxNumber": "718-946-7964",
"FirstLinePracticeLocationAddress": "170 AVENUE S",
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"PracticeLocationAddressCityName": "BROOKLYN",
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"PracticeLocationAddressTelephoneNumber": "718-382-8282",
"PracticeLocationAddressFaxNumber": "718-946-7964",
"EnumerationDate": "06/06/2007",
"LastUpdateDate": "11/29/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOYFMAN",
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"AuthorizedOfficialTitle": "PHYSICIAN",
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"AuthorizedOfficialCredential": "M.D., D.O.",
"AuthorizedOfficialTelephoneNumber": "718-382-8282",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "204787",
"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."
}
}
}
}