{
"Npi": {
"NPI": "1578831814",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PALACIO",
"FirstName": "CHRISTINE",
"MiddleName": "SUZANNE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OFFICE MANAGER/OWNER",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BOECKER",
"OtherFirstName": "KARL",
"OtherMiddleName": "LUDWIG",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "BC-HIS",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "2297 MIDDLE COUNTRY RD",
"SecondLineMailingAddress": "SUITE A",
"MailingAddressCityName": "CENTEREACH",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11720-3666",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "631-585-1212",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2297 MIDDLE COUNTRY RD",
"SecondLinePracticeLocationAddress": "SUITE A",
"PracticeLocationAddressCityName": "CENTEREACH",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11720-3666",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "631-585-1212",
"PracticeLocationAddressFaxNumber": "631-585-1006",
"EnumerationDate": "12/01/2011",
"LastUpdateDate": "12/01/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332S00000X",
"TaxonomyName": "Hearing Aid Equipment",
"LicenseNumber": "14000001167",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}