{
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"FirstLineMailingAddress": "7 SHORE RD",
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"MailingAddressCityName": "STONY BROOK",
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"MailingAddressPostalCode": "11790-1407",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-942-5209",
"MailingAddressFaxNumber": "631-458-1651",
"FirstLinePracticeLocationAddress": "887 OLD COUNTRY RD",
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"PracticeLocationAddressCityName": "RIVERHEAD",
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"PracticeLocationAddressTelephoneNumber": "631-591-3288",
"PracticeLocationAddressFaxNumber": "631-458-1651",
"EnumerationDate": "06/04/2015",
"LastUpdateDate": "09/25/2015",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "CEA",
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"AuthorizedOfficialCredential": "M.S CCC-SLP",
"AuthorizedOfficialTelephoneNumber": "631-942-5209",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Hearing and Speech Clinic/Center",
"LicenseNumber": "013688",
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}
},
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}
}