Michael Anthony Prybicien, A.T.C. EMTB, C.S.C.S

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

25MT00062100 Issued in NJ

Practice address

799 Bloomfield Avenue
Suite 304
Verona, NJ 07044-1301

Phone

(973) 571-0001

Fax

(973) 571-4170

NPI assigned

Feb 2, 2006

Sex

Male

Sole proprietor

Yes

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": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340755200000",
    "number": "1891767901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 PATRICIA PL",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070121855",
            "telephone_number": "973-594-9651",
            "fax_number": "973-571-4170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "799 BLOOMFIELD AVENUE",
            "address_2": "SUITE 304",
            "city": "VERONA",
            "state": "NJ",
            "postal_code": "070441301",
            "telephone_number": "973-571-0001",
            "fax_number": "973-571-4170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRYBICIEN",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "name_prefix": "Mr.",
        "credential": "A.T.C. EMTB, C.S.C.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2012-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NJ",
            "license": "25MT00062100",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT001246A",
            "primary": false
        },
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "NJ",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Verona, NJ
• Providers in Verona, NJ by specialty
• Athletic Trainer in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; 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.