{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "PALLIATIVE CARE CONSULTING SERVICES LLC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "382 HIGH RIDGE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STAMFORD",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06905-3019",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-219-7896",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1188 FOX ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BRONX",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10459-1810",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "203-219-7896",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/21/2020",
"LastUpdateDate": "12/16/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JEAN-PIERRE",
"AuthorizedOfficialFirstName": "GANNEL",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CONSULTANT",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "203-219-7896",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}