{
"Npi": {
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"EIN": null,
"IsSoleProprietor": "N",
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"LastName": "GABALLA",
"FirstName": "JEFFERSON",
"MiddleName": "G A",
"NamePrefix": "MR.",
"NameSuffix": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 15315",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JERSEY CITY",
"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07305",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "201-432-2865",
"MailingAddressFaxNumber": "201-915-1722",
"FirstLinePracticeLocationAddress": "166 MADISON AVE",
"SecondLinePracticeLocationAddress": "3RD FLOOR",
"PracticeLocationAddressCityName": "NEW YORK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "10016",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "212-687-5560",
"PracticeLocationAddressFaxNumber": "212-687-5530",
"EnumerationDate": "10/17/2007",
"LastUpdateDate": "10/17/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208D00000X",
"TaxonomyName": "General Practice Physician",
"LicenseNumber": "203423",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}