Ewa Antonczyk MD LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2005-0482 Issued in NM

Legal business name

EWA ANTONCZYK MD LLC

Practice address

3850 Foothills Rd
Ste. 9
Las Cruces, NM 88011-4632

Phone

(575) 382-3700

Fax

(575) 382-3701

NPI assigned

May 22, 2007

Last updated

May 6, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katrina M Ferrales

Title

Credentialing Specialist

Phone

(575) 647-8366

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1972713816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3850 FOOTHILLS RD",
            "address_2": "STE. 9",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114632",
            "telephone_number": "575-382-3700",
            "fax_number": "575-382-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3850 FOOTHILLS RD",
            "address_2": "STE. 9",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114632",
            "telephone_number": "575-382-3700",
            "fax_number": "575-382-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EWA ANTONCZYK MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "FERRALES",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "575-647-8366"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "2005-0482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64355381",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; 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.