1275846362 NPI number — REJUVENESSE

Table of content: DR. GARET JEFFERSON ZAUGG D.O. (NPI 1003264151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275846362 NPI number — REJUVENESSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REJUVENESSE
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:
1275846362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5911 NORTHWEST HWY
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
CRYSTAL LAKE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60014-8065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-788-1992
Provider Business Mailing Address Fax Number:
815-788-1993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5911 NORTHWEST HWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60014-8065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-788-1992
Provider Business Practice Location Address Fax Number:
815-788-1993
Provider Enumeration Date:
07/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAIDER
Authorized Official First Name:
SYED
Authorized Official Middle Name:
WASEEM
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
815-788-1992

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036100063 , 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)