1538108550 NPI number — ROLAND S MEDANSKY & RAYMOND M HANDLER

Table of content: (NPI 1538108550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538108550 NPI number — ROLAND S MEDANSKY & RAYMOND M HANDLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROLAND S MEDANSKY & RAYMOND M HANDLER
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:
1538108550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8780 W GOLF RD
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
NILES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60714-5602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-299-1044
Provider Business Mailing Address Fax Number:
847-299-0425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8780 W GOLF RD
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60714-5602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-299-1044
Provider Business Practice Location Address Fax Number:
847-299-0425
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HANDLER
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
847-299-1044

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0163954584 . This is a "CHICAGO BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 216-00658-36 . This is a "NILES BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2162065856 . This is a "CHICAGO BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0162954574 . This is a "NILES BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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