{
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"FirstLineMailingAddress": "PO BOX 1546",
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"MailingAddressCityName": "PORT WASHINGTON",
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"FirstLinePracticeLocationAddress": "90 BAR BEACH RD",
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"PracticeLocationAddressCityName": "PORT WASHINGTON",
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"EnumerationDate": "01/26/2016",
"LastUpdateDate": "01/26/2016",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ROBERTS",
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"AuthorizedOfficialTelephoneNumber": "917-688-2405",
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"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
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}
}
}
}