{
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"OrgName": "MARC A. BRENNER, D.P.M., PLLC",
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"FirstLineMailingAddress": "83 WHEATLEY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OLD WESTBURY",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11568-1210",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-355-2277",
"MailingAddressFaxNumber": "516-626-9243",
"FirstLinePracticeLocationAddress": "2001 MARCUS AVENUE",
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"PracticeLocationAddressCityName": "LAKE SUCCESS",
"PracticeLocationAddressStateName": "NY",
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"PracticeLocationAddressTelephoneNumber": "516-355-2277",
"PracticeLocationAddressFaxNumber": "516-626-9243",
"EnumerationDate": "12/27/2011",
"LastUpdateDate": "01/03/2019",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WELCH",
"AuthorizedOfficialFirstName": "SHARESE",
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"AuthorizedOfficialTitle": "CREDENTIALING SPECIALIST",
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"AuthorizedOfficialTelephoneNumber": "718-573-1123",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Podiatrist",
"LicenseNumber": "N002371-1",
"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."
}
}
}
}