{
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"FirstLineMailingAddress": "641 LEXINGTON AVENUE",
"SecondLineMailingAddress": "15TH FLOOR",
"MailingAddressCityName": "NEW YORK",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-584-4174",
"MailingAddressFaxNumber": "212-656-1933",
"FirstLinePracticeLocationAddress": "641 LEXINGTON AVE",
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"PracticeLocationAddressTelephoneNumber": "212-879-6381",
"PracticeLocationAddressFaxNumber": "212-717-8990",
"EnumerationDate": "03/16/2016",
"LastUpdateDate": "09/06/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HENNINGO",
"AuthorizedOfficialFirstName": "MATTHEW",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "212-355-5134",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Urology Physician",
"LicenseNumber": "211661",
"LicenseNumberStateCode": "NY",
"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."
}
}
}
}