1568662740 NPI number — CSQUARED PEDIATRIC DEVELOPMENTAL SERVICES, INC.

Table of content: MR. CHRISTOPHER JOHN COLBY MA (NPI 1609090331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568662740 NPI number — CSQUARED PEDIATRIC DEVELOPMENTAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CSQUARED PEDIATRIC DEVELOPMENTAL SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568662740
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1448 E 52ND ST
Provider Second Line Business Mailing Address:
SUITE #161
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60615-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-450-8777
Provider Business Mailing Address Fax Number:
877-588-6007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1448 E 52ND ST
Provider Second Line Business Practice Location Address:
SUITE #161
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60615-4122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-450-8777
Provider Business Practice Location Address Fax Number:
877-588-6007
Provider Enumeration Date:
07/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
CHRISHON
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
DIRECTOR/DEVELOPMENTAL THERAPIST
Authorized Official Telephone Number:
866-450-8777

Provider Taxonomy Codes

  • Taxonomy code: 222Q00000X , with the licence number:  CW71491203P , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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