Fred A Podbielak, OPTHALMIC DISPENSER

Primary specialty

OpticianTaxonomy code 156FX1800X

License

TD-2296 Issued in NJ

Practice address

701 Newark Ave
Ste 204
Elizabeth, NJ 07208-3550

Phone

(908) 355-2774

Fax

(908) 355-1185

NPI assigned

May 23, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1437369667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 NEWARK AVE",
            "address_2": "STE 204",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072083550",
            "telephone_number": "908-355-2774",
            "fax_number": "908-355-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 NEWARK AVE",
            "address_2": "STE 204",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072083550",
            "telephone_number": "908-355-2774",
            "fax_number": "908-355-1185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PODBIELAK",
        "first_name": "FRED",
        "middle_name": "A",
        "credential": "OPTHALMIC DISPENSER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": "NJ",
            "license": "TD-2296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6777104",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optician in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Optician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.