{
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"FirstLineMailingAddress": "165 BOSTON POST RD",
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"MailingAddressCityName": "EAST LYME",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06333-1605",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "165 BOSTON POST RD",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/21/2007",
"LastUpdateDate": "05/04/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BUCK",
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"AuthorizedOfficialTelephoneNumber": "860-739-1208",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Local Education Agency (LEA)",
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"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}