{
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"FirstLineMailingAddress": "4908 BURNLEY DR",
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"FirstLinePracticeLocationAddress": "4601 IRONBOUND RD.",
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"EnumerationDate": "11/19/2005",
"LastUpdateDate": "07/08/2007",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
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"TaxonomyName": "General Practice Physician",
"LicenseNumber": "0101025518",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}