Active NPI
Anthony James Jedwabny, ATC, CSCS
- Athletic Trainer
- Altamonte Springs, FL
National Provider Identifier
1790992097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL1198
- Practice address
- 185 S Westmonte Dr Ste 1208
Altamonte Springs, FL 32714-4200 - Phone
- (407) 733-2841
- NPI assigned
- May 17, 2007
- Last updated
- Aug 13, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 | AL1198 | FL | Primary |
Addresses
Primary practice location
185 S Westmonte Dr Ste 1208
Altamonte Springs, FL 32714-4200
Mailing address
178 Peshekee Trail
Medford, NJ 08055
Phone (407) 862-0714
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 |
|---|---|---|---|
| AL1198 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565654400000",
"number": "1790992097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "178 PESHEKEE TRAIL",
"city": "MEDFORD",
"state": "NJ",
"postal_code": "08055",
"telephone_number": "407-862-0714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "185 S WESTMONTE DR STE 1208",
"city": "ALTAMONTE SPRINGS",
"state": "FL",
"postal_code": "327144200",
"telephone_number": "407-733-2841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEDWABNY",
"first_name": "ANTHONY",
"middle_name": "JAMES",
"credential": "ATC, CSCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2019-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL1198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Altamonte Springs, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.