{
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"FirstLineMailingAddress": "21 ROCKLAND ST",
"SecondLineMailingAddress": "UNIT M",
"MailingAddressCityName": "CANTON",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02021-5104",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "205-266-8811",
"MailingAddressFaxNumber": "205-266-8811",
"FirstLinePracticeLocationAddress": "21 ROCKLAND ST",
"SecondLinePracticeLocationAddress": "UNIT M",
"PracticeLocationAddressCityName": "CANTON",
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"PracticeLocationAddressTelephoneNumber": "205-266-8811",
"PracticeLocationAddressFaxNumber": "205-266-8811",
"EnumerationDate": "11/20/2012",
"LastUpdateDate": "01/28/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ELREFAI",
"AuthorizedOfficialFirstName": "ALAA",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "205-266-8811",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084P2900X",
"TaxonomyName": "Pain Medicine (Psychiatry & Neurology) Physician",
"LicenseNumber": "52005",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}