{
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"FirstLineMailingAddress": "63-33 98TH PLACE",
"SecondLineMailingAddress": "SUITE 6G",
"MailingAddressCityName": "REGO PARK",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11374",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "63-33 98TH PLACE",
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"EnumerationDate": "07/15/2013",
"LastUpdateDate": "07/15/2013",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "GAL",
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"AuthorizedOfficialCredential": "MSED",
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"Taxonomies": {
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"TaxonomyName": "Early Intervention Provider Agency",
"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}