{
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"FirstLineMailingAddress": "1191 SUNRISE HWY",
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"MailingAddressFaxNumber": "631-206-1273",
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"EnumerationDate": "03/09/2007",
"LastUpdateDate": "08/02/2022",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KAHN",
"AuthorizedOfficialFirstName": "HENRY",
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{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}