{
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"FirstLineMailingAddress": "1224 OSTRANDER AVENUE",
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"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "631-727-2866",
"FirstLinePracticeLocationAddress": "502 UNION BLVD",
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"PracticeLocationAddressCityName": "WEST ISLIP",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/15/2020",
"LastUpdateDate": "12/03/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WILLIAMS",
"AuthorizedOfficialFirstName": "JEFFREY",
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"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "OD",
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"Taxonomy": [
{
"TaxonomyCode": "332H00000X",
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}