{
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"EIN": null,
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"IsOrgSubpart": "N",
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"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4678 BOSTON POST RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PELHAM",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "10803-3055",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "914-738-2885",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4678 BOSTON POST RD",
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"PracticeLocationAddressCityName": "PELHAM",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressTelephoneNumber": "914-738-2885",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/10/2013",
"LastUpdateDate": "09/25/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FARBER",
"AuthorizedOfficialFirstName": "BRUCE",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "914-738-2885",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332H00000X",
"TaxonomyName": "Eyewear Supplier",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}