{
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"FirstLineMailingAddress": "11064 QUEENS BLVD",
"SecondLineMailingAddress": "#129",
"MailingAddressCityName": "FOREST HILLS",
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"MailingAddressPostalCode": "11375-6347",
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"MailingAddressTelephoneNumber": "718-541-1449",
"MailingAddressFaxNumber": "718-712-3343",
"FirstLinePracticeLocationAddress": "1 CROSS ISLAND PLZ",
"SecondLinePracticeLocationAddress": "SUITE 220A",
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"PracticeLocationAddressTelephoneNumber": "718-541-1449",
"PracticeLocationAddressFaxNumber": "718-712-3343",
"EnumerationDate": "04/25/2008",
"LastUpdateDate": "04/25/2008",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "CORLEY",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialTelephoneNumber": "718-541-1449",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychiatry Physician",
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"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}