{
"Npi": {
"NPI": "1205042694",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VONKORFF",
"FirstName": "PETER",
"MiddleName": null,
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "PH.D",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 231",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BEMUS POINT",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14712-0231",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-386-1019",
"MailingAddressFaxNumber": "716-386-1020",
"FirstLinePracticeLocationAddress": "120 E 2ND ST",
"SecondLinePracticeLocationAddress": "THIRD FLOOR",
"PracticeLocationAddressCityName": "ERIE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "16507-1537",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-753-0077",
"PracticeLocationAddressFaxNumber": "716-720-5952",
"EnumerationDate": "05/15/2007",
"LastUpdateDate": "08/16/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "009060-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103T00000X",
"TaxonomyName": "Psychologist",
"LicenseNumber": "PS0093766",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}