{
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"EIN": null,
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"OtherOrgName": null,
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"FirstLineMailingAddress": "20 LEEDS ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HUNTINGTON STATION",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11746-4319",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-385-0187",
"MailingAddressFaxNumber": "631-385-0187",
"FirstLinePracticeLocationAddress": "33 WALT WHITMAN RD",
"SecondLinePracticeLocationAddress": "STE. 300B",
"PracticeLocationAddressCityName": "HUNTINGTON STATION",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-682-6654",
"PracticeLocationAddressFaxNumber": "631-385-0187",
"EnumerationDate": "02/13/2007",
"LastUpdateDate": "07/08/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Case Manager/Care Coordinator",
"LicenseNumber": "047433-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}