{
"Npi": {
"NPI": "1700416518",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VICCARO",
"FirstName": "ELIZABETH",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PHD., CCC-SLP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SITLER",
"OtherFirstName": "ELIZABETH",
"OtherMiddleName": "VICCARO",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "378 BEVERLY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DOUGLASTON",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11363-1125",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "917-572-5834",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6530 KISSENA BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLUSHING",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11367-1597",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-997-2930",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/21/2020",
"LastUpdateDate": "01/21/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "235Z00000X",
"TaxonomyName": "Speech-Language Pathologist",
"LicenseNumber": "011168",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}