{
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"EIN": null,
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"FirstLineMailingAddress": "3 DWIGHT AVE",
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"MailingAddressCityName": "CLINTON",
"MailingAddressStateName": "NY",
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"FirstLinePracticeLocationAddress": "160 BENMONT AVE STE 30",
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"PracticeLocationAddressCityName": "BENNINGTON",
"PracticeLocationAddressStateName": "VT",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "802-447-2110",
"PracticeLocationAddressFaxNumber": "802-447-2115",
"EnumerationDate": "10/30/2008",
"LastUpdateDate": "09/25/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111N00000X",
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"PrimaryTaxonomySwitch": "N"
},
{
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}