{
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"EIN": null,
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"IsOrgSubpart": "N",
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"LastName": null,
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"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "12 SCHOOL RD W",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MARLBORO",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07746-1507",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-617-6060",
"MailingAddressFaxNumber": "732-719-2323",
"FirstLinePracticeLocationAddress": "12 SCHOOL RD W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARLBORO",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "732-617-6060",
"PracticeLocationAddressFaxNumber": "732-719-2323",
"EnumerationDate": "07/27/2012",
"LastUpdateDate": "12/30/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HISH",
"AuthorizedOfficialFirstName": "STANSISLAV",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHARMACIST IN CHARGE",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "732-617-6060",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "333600000X",
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
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},
{
"TaxonomyCode": "3336C0003X",
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"LicenseNumber": "28RS00726200",
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"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}