1831247550 NPI number — MAGDALINA BORISSOVA NIKOLOV DDS

Table of content: DR. ERIC R JOPPERI D.O. (NPI 1952421638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831247550 NPI number — MAGDALINA BORISSOVA NIKOLOV DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIKOLOV
Provider First Name:
MAGDALINA
Provider Middle Name:
BORISSOVA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARGIROVA
Provider Other First Name:
MAGDALINA
Provider Other Middle Name:
BORISSOVA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1831247550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2604 PATRIOT BLVD
Provider Second Line Business Mailing Address:
UNIT B
Provider Business Mailing Address City Name:
GLENVIEW
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60026-8024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-334-9968
Provider Business Mailing Address Fax Number:
847-657-8818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2604 PATRIOT BLVD
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60026-8024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-657-8858
Provider Business Practice Location Address Fax Number:
847-657-8858
Provider Enumeration Date:
01/08/2007

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: 122300000X , with the licence number:  019-026203 , 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: 9199867 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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