{
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"FirstLineMailingAddress": "265 HACKENSACK ST UNIT 1129",
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"FirstLinePracticeLocationAddress": "275 WASHINGTON PL",
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"EnumerationDate": "05/04/2023",
"LastUpdateDate": "08/07/2023",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BALLARD",
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"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}