{
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"FirstLineMailingAddress": "100 E 77TH ST",
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"MailingAddressCityName": "NEW YORK",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "130 E 77TH STREET",
"SecondLinePracticeLocationAddress": "5 BLACK HALL",
"PracticeLocationAddressCityName": "NEW YORK",
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"EnumerationDate": "03/24/2016",
"LastUpdateDate": "08/20/2021",
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"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Nephrology Physician",
"LicenseNumber": "300435-01",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}