{
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"FirstLineMailingAddress": "27 NAEK RD",
"SecondLineMailingAddress": "SUITE 2",
"MailingAddressCityName": "VERNON",
"MailingAddressStateName": "CT",
"MailingAddressPostalCode": "06066-3965",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "860-875-2444",
"MailingAddressFaxNumber": "860-875-1952",
"FirstLinePracticeLocationAddress": "27 NAEK RD",
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"PracticeLocationAddressCityName": "VERNON",
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"PracticeLocationAddressTelephoneNumber": "860-875-2444",
"PracticeLocationAddressFaxNumber": "860-875-1952",
"EnumerationDate": "02/24/2014",
"LastUpdateDate": "02/27/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANWAR",
"AuthorizedOfficialFirstName": "MOHAMMAD",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "860-875-2444",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "5638",
"LicenseNumberStateCode": "CT",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}