{
"Npi": {
"NPI": "1972815397",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JOSE A. GONZALEZ DC PC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7 MAYFIELD DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MASTIC BEACH",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11951-1704",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-219-1706",
"MailingAddressFaxNumber": "631-922-8878",
"FirstLinePracticeLocationAddress": "1805 5TH AVE",
"SecondLinePracticeLocationAddress": "SUITE 2",
"PracticeLocationAddressCityName": "BAY SHORE",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11706-1761",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-219-1706",
"PracticeLocationAddressFaxNumber": "631-922-8878",
"EnumerationDate": "07/14/2010",
"LastUpdateDate": "07/14/2010",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GONZALEZ",
"AuthorizedOfficialFirstName": "JOSE",
"AuthorizedOfficialMiddleName": "A",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DC",
"AuthorizedOfficialTelephoneNumber": "631-219-1706",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261Q00000X",
"TaxonomyName": "Clinic/Center",
"LicenseNumber": "XOO8699-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}