{
"Npi": {
"NPI": "1215412572",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BUSCHBACH",
"FirstName": "JACQUELINE",
"MiddleName": "COLLEEN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "603 HAMILTON PKWY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SYRACUSE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "13214-2312",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "773-320-9352",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4 CHENANGO ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CAZENOVIA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "13035-1400",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "570-735-8754",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/02/2018",
"LastUpdateDate": "06/02/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "060956",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}