Active NPI
Ethan T Pcolar, ATC
- Athletic Trainer
- Campbell, CA
National Provider Identifier
1841648870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000021531
- Practice address
- 4805 Westmont Ave
Campbell, CA 95008-5725 - Phone
- (845) 518-4259
- NPI assigned
- May 31, 2016
- 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 | 2000021531 | NY | Primary |
Addresses
Primary practice location
4805 Westmont Ave
Campbell, CA 95008-5725
Mailing address
945 Foothill Dr
San Jose, CA 95123-2628
Phone (845) 518-4259
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 |
|---|---|---|---|
| 2000021531 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464652800000",
"number": "1841648870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "945 FOOTHILL DR",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951232628",
"telephone_number": "845-518-4259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 WESTMONT AVE",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950085725",
"telephone_number": "845-518-4259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PCOLAR",
"first_name": "ETHAN",
"middle_name": "T",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-31",
"last_updated": "2016-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "2000021531",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Campbell, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.