{
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"FirstLineMailingAddress": "199 BOWERY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NEW YORK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10002-2853",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "917-733-6821",
"MailingAddressFaxNumber": "212-358-9996",
"FirstLinePracticeLocationAddress": "199 BOWERY",
"SecondLinePracticeLocationAddress": "2B",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressFaxNumber": "212-358-9996",
"EnumerationDate": "08/02/2017",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRADY",
"AuthorizedOfficialFirstName": "SUZANNE",
"AuthorizedOfficialMiddleName": "JANE",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "MS ED",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Contractor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}