{
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"EIN": null,
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"FirstLineMailingAddress": "183 FLORIDA ST # 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BUFFALO",
"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-886-6843",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "183 FLORIDA ST # 2",
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"PracticeLocationAddressCityName": "BUFFALO",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-886-6843",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/17/2018",
"LastUpdateDate": "08/17/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CLEMONS",
"AuthorizedOfficialFirstName": "STEPHANIE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/OPERATOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "716-465-4888",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Taxi",
"LicenseNumber": "402488020",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}