{
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"OrgName": "ICD CENTER",
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"FirstLineMailingAddress": "2350 OCEAN AVE APT 7F",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BROOKLYN",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11229-3043",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-585-6271",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "340 E 24TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/05/2006",
"LastUpdateDate": "07/21/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SAMIOS",
"AuthorizedOfficialFirstName": "GEORGE",
"AuthorizedOfficialMiddleName": "KONSTANTINE",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM0801X",
"TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
"LicenseNumber": "087199",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}