1609987767 NPI number — DR. SWARTZ IMAGING OF ILLINOIS

Table of content: (NPI 1609987767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609987767 NPI number — DR. SWARTZ IMAGING OF ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. SWARTZ IMAGING OF ILLINOIS
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:
6
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:
1609987767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 768
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10018-0025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-360-2233
Provider Business Mailing Address Fax Number:
410-360-2234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8618 W GOLF RD # 8620
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60714-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-360-2233
Provider Business Practice Location Address Fax Number:
410-360-2234
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENBERG
Authorized Official First Name:
MAURY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-360-2233

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001633112 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com