1386615904 NPI number — DR. EBRAHIM AMANI M.D.

Table of content: NELLIE HARASIMOWICZ LCSW (NPI 1477033264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386615904 NPI number — DR. EBRAHIM AMANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMANI
Provider First Name:
EBRAHIM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1386615904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1049 E WILSON ST
Provider Second Line Business Mailing Address:
SUITE 160B
Provider Business Mailing Address City Name:
BATAVIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60510-2474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-232-2776
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1049 E WILSON ST
Provider Second Line Business Practice Location Address:
SUITE 160B
Provider Business Practice Location Address City Name:
BATAVIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60510-2474
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-232-2776
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  36-95344 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 3695344 , 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: P01160490 . This is a "MEDICARE RAIL ROAD PTAN (INDIVIDUAL)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036095344 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 920540 . This is a "MEDICARE PTAN (GROUP)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 920540035 . This is a "MEDICARE PTAN (INDIVIDUAL)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CA4748 . This is a "MEDICARE RAIL ROAD PTAN (GROUP)" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com