{
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"FirstLineMailingAddress": "5875 NIGHT WIND CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JAMESVILLE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13078-6475",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-564-3687",
"MailingAddressFaxNumber": "315-299-5319",
"FirstLinePracticeLocationAddress": "5875 NIGHT WIND CIR",
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"PracticeLocationAddressCityName": "JAMESVILLE",
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"PracticeLocationAddressTelephoneNumber": "718-564-3687",
"PracticeLocationAddressFaxNumber": "315-359-6778",
"EnumerationDate": "07/19/2010",
"LastUpdateDate": "11/07/2022",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SUMAGAYSAY",
"AuthorizedOfficialFirstName": "ACE",
"AuthorizedOfficialMiddleName": "GONZALES",
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"AuthorizedOfficialCredential": "PT, DPT",
"AuthorizedOfficialTelephoneNumber": "718-564-3687",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225100000X",
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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{
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE 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."
}
]
}
}
}