{
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"FirstLineMailingAddress": "36 ASPEN RD",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "NY",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "646-577-6654",
"MailingAddressFaxNumber": "347-374-6315",
"FirstLinePracticeLocationAddress": "36 ASPEN RD",
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"PracticeLocationAddressCityName": "KINGS PARK",
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"EnumerationDate": "05/26/2009",
"LastUpdateDate": "05/26/2009",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CHI",
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"AuthorizedOfficialCredential": "MD",
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"Taxonomies": {
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"TaxonomyName": "Supports Brokerage Agency",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}