Active NPI
Susan Mary Wielgosz, ATC
- Athletic Trainer
- Brockport, NY
National Provider Identifier
1720018385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 000027-1
- Practice address
- 350 New Campus Dr
Suny College at Brockport
Brockport, NY 14420-2997 - Phone
- (585) 395-5358
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 000027-1 | NY | Primary |
Addresses
Primary practice location
350 New Campus Dr
Suny College at Brockport
Brockport, NY 14420-2997
Mailing address
10 Tearose Meadow LN
Brockport, NY 14420-9336
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000027-1 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720018385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 TEAROSE MEADOW LN",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144209336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "350 NEW CAMPUS DR",
"address_2": "SUNY COLLEGE AT BROCKPORT",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144202997",
"telephone_number": "585-395-5358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIELGOSZ",
"first_name": "SUSAN",
"middle_name": "MARY",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "000027-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.