{
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"NPI": "1871798710",
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
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"OrgName": "55 SANDALWOOD ENTERPRISES INC",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "818 E MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIVERHEAD",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11901-2563",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-284-2299",
"MailingAddressFaxNumber": "631-284-2305",
"FirstLinePracticeLocationAddress": "3400 BAINBRIDGE AVE",
"SecondLinePracticeLocationAddress": "3RD FLOOR",
"PracticeLocationAddressCityName": "BRONX",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10467",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-920-4333",
"PracticeLocationAddressFaxNumber": "718-547-2907",
"EnumerationDate": "06/20/2007",
"LastUpdateDate": "09/13/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CARR",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": "G",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "631-284-2299",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "237600000X",
"TaxonomyName": "Audiologist-Hearing Aid Fitter",
"LicenseNumber": null,
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}