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"FirstLineMailingAddress": "615 EAST 162ND STREET",
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"MailingAddressCityName": "SOUTH HOLLAND",
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"EnumerationDate": "05/08/2007",
"LastUpdateDate": "08/22/2020",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GORMAN",
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"AuthorizedOfficialMiddleName": "MICHAEL",
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"AuthorizedOfficialCredential": "DDS",
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{
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}
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},
"HealthcareProviderTaxonomyGroups": {
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},
{
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}
]
}
}
}