{
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"LastName": null,
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"NamePrefix": null,
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"FirstLineMailingAddress": "2530 14TH ST FL 2",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ASTORIA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11102-3721",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-577-4074",
"MailingAddressFaxNumber": "718-426-5110",
"FirstLinePracticeLocationAddress": "9254 QUEENS BLVD",
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"PracticeLocationAddressCityName": "REGO PARK",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11374-1040",
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"PracticeLocationAddressTelephoneNumber": "718-426-5100",
"PracticeLocationAddressFaxNumber": "718-426-5110",
"EnumerationDate": "10/14/2014",
"LastUpdateDate": "10/14/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "PECACHE",
"AuthorizedOfficialFirstName": "JOHN",
"AuthorizedOfficialMiddleName": "MICHAEL",
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"AuthorizedOfficialCredential": "P.T.",
"AuthorizedOfficialTelephoneNumber": "646-577-4074",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "027839",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}