{
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"EIN": null,
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"OtherLastName": "ROOTBERG",
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"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "223 BERGEN ST.",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKLYN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11217",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-243-0783",
"MailingAddressFaxNumber": "718-243-0783",
"FirstLinePracticeLocationAddress": "374 5TH AVE.",
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"PracticeLocationAddressCityName": "BROOKLYN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-499-5238",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/01/2008",
"LastUpdateDate": "10/01/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2000X",
"TaxonomyName": "Physical Therapy Clinic/Center",
"LicenseNumber": "002960-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}