{
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"FirstLineMailingAddress": "41 UNIVERSITY DR",
"SecondLineMailingAddress": "SUITE 300",
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"MailingAddressFaxNumber": "215-710-5181",
"FirstLinePracticeLocationAddress": "4595 NEW FALLS RD",
"SecondLinePracticeLocationAddress": "SUITE A",
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"PracticeLocationAddressTelephoneNumber": "267-587-3700",
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"EnumerationDate": "05/04/2016",
"LastUpdateDate": "12/27/2023",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PROFERA",
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"AuthorizedOfficialTitle": "DIRECTOR OF FINANCE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "215-710-2013",
"Taxonomies": {
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"TaxonomyName": "Family Medicine Physician",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}
}
}