1447305644 NPI number — SHARI L. BORNSTEIN MD

Table of content: HEATHER BROWN RN (NPI 1770033532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447305644 NPI number — SHARI L. BORNSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARI L. BORNSTEIN MD
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:
1447305644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 N. RIVERSIDE DR
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
GURNEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60031-2701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-662-4300
Provider Business Mailing Address Fax Number:
847-662-2008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N. RIVERSIDE DR
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
GURNEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60031-2701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-662-4300
Provider Business Practice Location Address Fax Number:
847-662-2008
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORNSTEIN
Authorized Official First Name:
SHARI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
847-662-4300

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036082237 , 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)

  • Identifier: 4932064 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com