{
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"FirstLineMailingAddress": "18 CHURCH STREET",
"SecondLineMailingAddress": "FIRE DEPARTMENT",
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"FirstLinePracticeLocationAddress": "11 BROADWAY",
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"PracticeLocationAddressCityName": "NORTH HAVEN",
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"EnumerationDate": "12/08/2017",
"LastUpdateDate": "09/26/2024",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": "02/18/2022",
"NPIReactivationDate": "03/11/2022",
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JANUSZEWSKI",
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"AuthorizedOfficialTitle": "FIRE CHIEF",
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"AuthorizedOfficialTelephoneNumber": "203-239-5321",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}