{
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"FirstLineMailingAddress": "505 INDEPENDENCE RD",
"SecondLineMailingAddress": "SUITE C",
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"MailingAddressStateName": "PA",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "570-421-5003",
"MailingAddressFaxNumber": "570-421-1401",
"FirstLinePracticeLocationAddress": "505 INDEPENDENCE RD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-421-5003",
"PracticeLocationAddressFaxNumber": "570-421-1401",
"EnumerationDate": "05/25/2006",
"LastUpdateDate": "08/22/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BIGATEL",
"AuthorizedOfficialFirstName": "DAVID",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "DELEGATED OFFICIAL",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "570-421-5003",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "MD051441L",
"LicenseNumberStateCode": "PA",
"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."
}
}
}
}