{
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"IsOrgSubpart": "N",
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"OrgName": "PORT JEFFERSON EKG ASSOCIATES",
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"FirstLineMailingAddress": "PO BOX 977",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PORT JEFFERSON STATION",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11776-0830",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-642-0183",
"MailingAddressFaxNumber": "631-642-0183",
"FirstLinePracticeLocationAddress": "JOHN T. MATHER MEMORIAL HOSPITAL",
"SecondLinePracticeLocationAddress": "75 NORTH COUNTRY ROAD",
"PracticeLocationAddressCityName": "PORT JEFFERSON",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressFaxNumber": "631-642-0183",
"EnumerationDate": "02/12/2008",
"LastUpdateDate": "05/21/2008",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROMANO",
"AuthorizedOfficialFirstName": "VIRGINIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "631-642-0183",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "120676",
"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."
}
}
}
}