{
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"FirstLineMailingAddress": "155 W MERRICK RD STE 201",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-726-4752",
"MailingAddressFaxNumber": "516-400-0144",
"FirstLinePracticeLocationAddress": "155 W MERRICK RD STE 201",
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"PracticeLocationAddressCityName": "FREEPORT",
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"EnumerationDate": "08/18/2023",
"LastUpdateDate": "12/17/2025",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "PACIUS",
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"AuthorizedOfficialTelephoneNumber": "516-726-4752",
"Taxonomies": {
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}