1427425529 NPI number — LAZARINA KOSTOVA PARASKEVOVA CSA

Table of content: LAZARINA KOSTOVA PARASKEVOVA CSA (NPI 1427425529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427425529 NPI number — LAZARINA KOSTOVA PARASKEVOVA CSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARASKEVOVA
Provider First Name:
LAZARINA
Provider Middle Name:
KOSTOVA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CSA
Provider Gender Code:
F

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:
1427425529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW LENOX
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60451-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-463-0098
Provider Business Mailing Address Fax Number:
815-462-4955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1245 WISE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELBURN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60119-9530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-463-0098
Provider Business Practice Location Address Fax Number:
815-462-4955
Provider Enumeration Date:
08/25/2015

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: 246ZC0007X , with the licence number:  238000455 , 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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