{
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"EIN": null,
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"FirstLineMailingAddress": "4621 E SENECA ST",
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"MailingAddressCityName": "SHERRILL",
"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "315-363-2046",
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"FirstLinePracticeLocationAddress": "267 HILL ROAD",
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"PracticeLocationAddressCityName": "ROME",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "315-338-7540",
"PracticeLocationAddressFaxNumber": "315-338-7538",
"EnumerationDate": "05/30/2012",
"LastUpdateDate": "03/04/2014",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Surgery Physician",
"LicenseNumber": "106450-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}