{
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"NamePrefix": null,
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"FirstLineMailingAddress": "565 JEWETT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "STATEN ISLAND",
"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-701-6010",
"MailingAddressFaxNumber": "718-447-7831",
"FirstLinePracticeLocationAddress": "565 JEWETT AVE",
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"PracticeLocationAddressCityName": "STATEN ISLAND",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-701-6010",
"PracticeLocationAddressFaxNumber": "718-447-7831",
"EnumerationDate": "10/24/2006",
"LastUpdateDate": "04/28/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PATHARE",
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"AuthorizedOfficialMiddleName": "S",
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "718-818-4892",
"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}