{
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"OrgName": "PLAZA ONE MEDICAL HEALTHCARE PC",
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"FirstLineMailingAddress": "894 OAKS DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FRANKLIN SQUARE",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11010-1936",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "516-270-2755",
"FirstLinePracticeLocationAddress": "835 61ST ST",
"SecondLinePracticeLocationAddress": "2ND FLOOR",
"PracticeLocationAddressCityName": "BROOKLYN",
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"PracticeLocationAddressPostalCode": "11220-4312",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-854-8869",
"PracticeLocationAddressFaxNumber": "718-854-8861",
"EnumerationDate": "03/10/2010",
"LastUpdateDate": "11/15/2013",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CUBANGBANG",
"AuthorizedOfficialFirstName": "DANTE",
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"AuthorizedOfficialTitle": "PRESIDENT- OWNER",
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"AuthorizedOfficialCredential": "M.D.",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2081P2900X",
"TaxonomyName": "Pain Medicine (Physical Medicine & Rehabilitation) Physician",
"LicenseNumber": "234017",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}