{
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"FirstLineMailingAddress": "1399 NEW SCOTLAND ROAD",
"SecondLineMailingAddress": "PO BOX 129",
"MailingAddressCityName": "SLINGERLANDS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "12159-0129",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "518-785-1100",
"MailingAddressFaxNumber": "518-785-1109",
"FirstLinePracticeLocationAddress": "7D JOHNSON RD",
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"PracticeLocationAddressCityName": "LATHAM",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressTelephoneNumber": "518-785-1100",
"PracticeLocationAddressFaxNumber": "518-785-1109",
"EnumerationDate": "12/08/2006",
"LastUpdateDate": "10/09/2018",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAYRON",
"AuthorizedOfficialFirstName": "CHARLES",
"AuthorizedOfficialMiddleName": "D",
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"AuthorizedOfficialCredential": "MD, FACS",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Specialist",
"LicenseNumber": "171638",
"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."
}
}
}
}