1760606073 NPI number — MR. IRVING SHELDON SANDACK R.PH.

Table of content: MR. IRVING SHELDON SANDACK R.PH. (NPI 1760606073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760606073 NPI number — MR. IRVING SHELDON SANDACK R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDACK
Provider First Name:
IRVING
Provider Middle Name:
SHELDON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
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:
1760606073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1508 CANBURY CT #D-2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090-6971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-537-5512
Provider Business Mailing Address Fax Number:
847-537-4346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S ROSELLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHAUMBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60193-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-301-0267
Provider Business Practice Location Address Fax Number:
847-524-4709
Provider Enumeration Date:
04/11/2007

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: 183500000X , 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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