{
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"OrgName": "GREAT NECK ACUPUNCTURIST & WELLNESS, PC",
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"FirstLineMailingAddress": "PO BOX 640781",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OAKLAND GARDENS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11364-0781",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-983-0714",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3016 30TH DR FL 2",
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"PracticeLocationAddressCityName": "ASTORIA",
"PracticeLocationAddressStateName": "NY",
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"EnumerationDate": "06/18/2012",
"LastUpdateDate": "06/18/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PARK",
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"AuthorizedOfficialCredential": "ACUPUNCTURIST",
"AuthorizedOfficialTelephoneNumber": "516-983-0714",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": "001083-1",
"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."
}
}
}
}