{"npi":"1992934467","type":"NPI-2","status":"active","name":{"display":"Queens Nassau Nephrology Services PLLC","other":[],"organization_name":"QUEENS NASSAU NEPHROLOGY SERVICES PLLC","authorised_official":"Andrey Goncharuk"},"specialty":{"primary_taxonomy":"207RN0300X","primary_taxonomy_description":"Nephrology Physician","slug":"nephrology-physician","schema_org_specialty":null,"all":[{"code":"207RN0300X","description":"Nephrology Physician","primary":false,"state":"NY","license":"199896"},{"code":"207R00000X","description":"Internal Medicine","primary":false,"state":"NY","license":null},{"code":"207RN0300X","description":"Nephrology Physician","primary":true,"state":"NY","license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"300 OLD COUNTRY ROAD","city":"MINEOLA","state":"NY","postal_code":"115014112","country_code":"US","street_2":"111","phone":"5167450500","fax":"5167451534"},{"purpose":"MAILING","street_1":"300 OLD COUNTRY ROAD","city":"MINEOLA","state":"NY","postal_code":"115014112","country_code":"US","street_2":"111","phone":"5167450500","fax":"5167451534"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"03340883","state":"NY","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20100505000080","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"NY","pac_id":"5597893057"}]},"enumeration_date":"2009-07-06","last_updated":"2014-12-05","_meta":{"source":"NPPES","snapshot_date":"2014-12-05","doc_url":"https://findmynpi.com/api"}}