{
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"FirstLineMailingAddress": "1 DAG HAMMARSKJOLD BLVD STE 5",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FREEHOLD",
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"MailingAddressPostalCode": "07728-5222",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "732-780-0769",
"MailingAddressFaxNumber": "732-414-7800",
"FirstLinePracticeLocationAddress": "1 DAG HAMMARSKJOLD BLVD STE 5",
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"PracticeLocationAddressCityName": "FREEHOLD",
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"PracticeLocationAddressTelephoneNumber": "732-780-0769",
"PracticeLocationAddressFaxNumber": "732-414-7800",
"EnumerationDate": "12/14/2023",
"LastUpdateDate": "12/14/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GRILL",
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"AuthorizedOfficialMiddleName": "D",
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"AuthorizedOfficialCredential": "DPM",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}