{
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "418 BROADWAY # 8706",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALBANY",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-823-9175",
"MailingAddressFaxNumber": "516-940-3784",
"FirstLinePracticeLocationAddress": "418 BROADWAY # 8706",
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"PracticeLocationAddressCityName": "ALBANY",
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"PracticeLocationAddressTelephoneNumber": "516-823-9175",
"PracticeLocationAddressFaxNumber": "516-940-3784",
"EnumerationDate": "03/16/2026",
"LastUpdateDate": "03/16/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LIN",
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"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "516-823-9175",
"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}