{
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"FirstLineMailingAddress": "1650 N SHORE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HADLEY",
"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-696-3789",
"MailingAddressFaxNumber": "518-696-5391",
"FirstLinePracticeLocationAddress": "1650 N SHORE RD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "518-696-3789",
"PracticeLocationAddressFaxNumber": "518-696-5391",
"EnumerationDate": "10/01/2012",
"LastUpdateDate": "05/25/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JONES",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "518-696-3789",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Land Ambulance",
"LicenseNumber": "30561",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}