{
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"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "718-255-3706",
"FirstLinePracticeLocationAddress": "1971 GRAND AVE",
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"PracticeLocationAddressFaxNumber": "718-255-3706",
"EnumerationDate": "12/22/2025",
"LastUpdateDate": "12/22/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELIYAHU",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "718-551-8201",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community/Retail Pharmacy",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}