{
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"FirstLineMailingAddress": "1053 BLOOMFIELD AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLIFTON",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07012-2120",
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"MailingAddressFaxNumber": "973-594-0120",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "973-594-0120",
"EnumerationDate": "06/24/2017",
"LastUpdateDate": "04/23/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RADTKE",
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"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/OPTOMETRIST",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "OD",
"AuthorizedOfficialTelephoneNumber": "201-913-7808",
"Taxonomies": {
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{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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},
{
"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."
}
]
}
}
}