{
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "GOMEZ NEUROLOGY",
"LastName": null,
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"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1252 KEYES AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SCHENECTADY",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12309-5728",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-285-0782",
"MailingAddressFaxNumber": "855-420-6025",
"FirstLinePracticeLocationAddress": "110 WOLF RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALBANY",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "12205-1244",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-650-2090",
"PracticeLocationAddressFaxNumber": "855-420-6025",
"EnumerationDate": "03/26/2015",
"LastUpdateDate": "04/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GOMEZ",
"AuthorizedOfficialFirstName": "FRANCISCO",
"AuthorizedOfficialMiddleName": "JAVIER",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "518-285-0782",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QM2500X",
"TaxonomyName": "Medical Specialty Clinic/Center",
"LicenseNumber": "473187",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}