Healthcare Provider Details

I. General information

NPI: 1235564766
Provider Name (Legal Business Name): ASSOCIATES IN NEUROSCIENCE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16W300 83RD ST STE 100
BURR RIDGE IL
60527-5848
US

IV. Provider business mailing address

16W300 83RD ST STE 100
BURR RIDGE IL
60527-5848
US

V. Phone/Fax

Practice location:
  • Phone: 630-230-3372
  • Fax: 630-568-5050
Mailing address:
  • Phone: 630-230-3372
  • Fax: 630-568-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006074
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number036072299
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. VIJAY SINGH
Title or Position: OFFICE MANAGER
Credential:
Phone: 630-673-9399