{
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"LastName": null,
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"FirstLineMailingAddress": "67 SAND PIT RD SUITE 308",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DANBURY",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06810-4032",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "203-743-7246",
"MailingAddressFaxNumber": "203-792-3920",
"FirstLinePracticeLocationAddress": "131 KENT RD BLDG A",
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"PracticeLocationAddressCityName": "NEW MILFORD",
"PracticeLocationAddressStateName": "CT",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "860-210-8161",
"PracticeLocationAddressFaxNumber": "860-210-8175",
"EnumerationDate": "12/07/2010",
"LastUpdateDate": "11/09/2016",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LEVI",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "203-743-7246",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "038785",
"LicenseNumberStateCode": "CT",
"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."
}
}
}
}