Active NPI
Mark Anthony Pedziwiatr Jr.
- Hand Physical Therapist
- Naperville, IL
National Provider Identifier
1669943700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hand Physical Therapist
- License
- 056012898
- Practice address
- 1259 Rickert Dr Ste 201
Naperville, IL 60540-8904 - Phone
- (630) 967-2000
- NPI assigned
- Dec 16, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hand Physical Therapist | 2251H1200X | 056012898 | IL | Primary |
Addresses
Primary practice location
1259 Rickert Dr Ste 201
Naperville, IL 60540-8904
Mailing address
1860 Payshere Circle
Chicago, IL 60674-8634
Phone (630) 469-9200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056012898 | IL | MD | Hand Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544918400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549843200000",
"number": "1669943700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1860 PAYSHERE CIRCLE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606748634",
"telephone_number": "630-469-9200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1259 RICKERT DR STE 201",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605408904",
"telephone_number": "630-967-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEDZIWIATR",
"first_name": "MARK",
"middle_name": "ANTHONY",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-12-16",
"last_updated": "2019-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "2251H1200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Hand",
"state": "IL",
"license": "056012898",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Naperville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.