{
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"FirstLineMailingAddress": "429 W 127TH ST",
"SecondLineMailingAddress": null,
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "212-222-3882",
"MailingAddressFaxNumber": "212-222-3882",
"FirstLinePracticeLocationAddress": "429 W 127TH ST",
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"PracticeLocationAddressCityName": "NEW YORK",
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"PracticeLocationAddressFaxNumber": "212-222-3882",
"EnumerationDate": "08/13/2020",
"LastUpdateDate": "08/13/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "NICHOLS",
"AuthorizedOfficialFirstName": "KIM",
"AuthorizedOfficialMiddleName": "ERICA",
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"AuthorizedOfficialCredential": "MPH, SCM",
"AuthorizedOfficialTelephoneNumber": "917-415-3505",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Community Health Worker",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}