{
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"FirstLineMailingAddress": "14238 37TH AVE STE 1D",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLUSHING",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11354-4580",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-886-8979",
"MailingAddressFaxNumber": "718-228-9172",
"FirstLinePracticeLocationAddress": "14238 37TH AVE STE 1D",
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"PracticeLocationAddressCityName": "FLUSHING",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-866-8979",
"PracticeLocationAddressFaxNumber": "718-228-9172",
"EnumerationDate": "02/21/2018",
"LastUpdateDate": "02/01/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MENDOZA",
"AuthorizedOfficialFirstName": "ALEX",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST",
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"AuthorizedOfficialCredential": "DPT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Rehabilitation Practitioner",
"LicenseNumber": "026971",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}