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1972869675 NPI number — PREMIUM MEDICAL OF NY,PC

NPI Number: 1972869675
Health Care Provider/Practitioner: PREMIUM MEDICAL OF NY,PC

Information about “1972869675” NPI (PREMIUM MEDICAL OF NY,PC) exists in 1972869675 in HTML format HTML  |  1972869675 in plain Text format TXT  |  1972869675 in PDF (Portable Document Format) PDF  |  1972869675 in an XML format XML  formats.

NPI Number : 1972869675 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972869675",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PREMIUM MEDICAL OF NY,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": "14709 ELM AVE",
    "SecondLineMailingAddress": "SUITE B1",
    "MailingAddressCityName": "FLUSHING",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11355-1705",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "718-445-1223",
    "MailingAddressFaxNumber": "718-445-1539",
    "FirstLinePracticeLocationAddress": "14709 ELM AVE",
    "SecondLinePracticeLocationAddress": "SUITE B1",
    "PracticeLocationAddressCityName": "FLUSHING",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11355-1705",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "718-445-1223",
    "PracticeLocationAddressFaxNumber": "718-445-1539",
    "EnumerationDate": "04/06/2012",
    "LastUpdateDate": "04/06/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GEORGIOU",
    "AuthorizedOfficialFirstName": "CHRISTOPHER",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "718-445-1223",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "193788",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RN0300X",
          "TaxonomyName": "Nephrology Physician",
          "LicenseNumber": "193788",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
        }
      ]
    }
  }
}
                
            

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