{
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"FirstLineMailingAddress": "11 HILTON PL",
"SecondLineMailingAddress": null,
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"MailingAddressStateName": "NJ",
"MailingAddressPostalCode": "07645-1206",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "210 SUMMIT AVE STE B1",
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"PracticeLocationAddressCityName": "MONTVALE",
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"EnumerationDate": "10/16/2019",
"LastUpdateDate": "11/19/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOPPELMAN",
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"AuthorizedOfficialCredential": "MSPT",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Physical Therapy Clinic/Center",
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}