Fred Antczak

Primary specialty

OrthotistTaxonomy code 222Z00000X

License

2255 Issued in VA

Practice address

17931 Pierce PLZ
Omaha, NE 68130-2654

Phone

(402) 933-1393

Fax

(402) 933-1899

NPI assigned

Dec 14, 2010

Last updated

Dec 14, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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": "1292284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292284800000",
    "number": "1649573676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17931 PIERCE PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302654",
            "telephone_number": "402-933-1393",
            "fax_number": "402-933-1899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17931 PIERCE PLZ",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681302654",
            "telephone_number": "402-933-1393",
            "fax_number": "402-933-1899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTCZAK",
        "first_name": "FRED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-14",
        "last_updated": "2010-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "VA",
            "license": "2255",
            "primary": true
        },
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "VA",
            "license": "0675",
            "primary": false
        },
        {
            "code": "225000000X",
            "taxonomy_group": "",
            "desc": "Orthotic Fitter",
            "state": "VA",
            "license": "2255",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthotist in Omaha, NE
• Providers in Omaha, NE by specialty
• Orthotist in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; 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.