{
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"EIN": null,
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"IsOrgSubpart": "N",
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"FirstLineMailingAddress": "5752 256TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LITTLE NECK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11362-2141",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4021 MAIN ST UNIT M4-M5",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLUSHING",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-799-0523",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/13/2022",
"LastUpdateDate": "11/28/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WU",
"AuthorizedOfficialFirstName": "RAYMOND",
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"AuthorizedOfficialTitle": "SUPERVISING PHARMACIST",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "718-971-3358",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}