{
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"FirstLineMailingAddress": "8132 256TH ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLEN OAKS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11004-1416",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "718-343-3401",
"MailingAddressFaxNumber": "718-343-3401",
"FirstLinePracticeLocationAddress": "202 FOSTER AVE",
"SecondLinePracticeLocationAddress": "SUITE D",
"PracticeLocationAddressCityName": "BROOKLYN",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11230-2119",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "646-831-9722",
"PracticeLocationAddressFaxNumber": "718-343-3401",
"EnumerationDate": "09/12/2015",
"LastUpdateDate": "09/12/2015",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KUNDU",
"AuthorizedOfficialFirstName": "SUBHENDU",
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"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "MD",
"AuthorizedOfficialTelephoneNumber": "646-831-9722",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "209274",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}